Medical Equipments & ACCESSORIES

By : Puneeth Kumar

( Biomedical Engineer )

Aug-2023

10/21/2023 Alem E. 1
Medical Equipment
3,000,000,000
2,000,000,000
1,000,000,000
0 2007 BY
2008 BY
2009 BY (11Months)
 Introduction
Medical Device

 The World Health Organization (WHO) differentiates the

mostly associated terms such as health technology, medical
device and medical equipment. Hence, the following
definitions:

 Health Technology: The application of organized knowledge

and skills in the form of devices, medicines, vaccines,
procedures and systems developed to solve a health problem
and improve quality of life. also It is used interchangeably with
health-care technology.
10/21/2023 Alem E. 3
 Medical device: An instrument, apparatus or machine that is
used in the prevention, diagnosis or treatment of illness or
disease, or for detecting, measuring, restoring, correcting or
modifying the structure or function of the body for some health
purpose.

Typically, the purpose of a medical device is not achieved by

pharmacological, immunological or metabolic means.

• It is intended to affect the structure or any function of
the body of man or other animals, and unlike drugs it
does not achieve its primary intended purposes through
chemical action within or on the body of man or
animals and is not dependent upon being metabolized
for the achievement of any of its primary intended
purpose.
 Medical equipment: Medical devices requiring calibration,
maintenance, repair, user training, and decommissioning –
activities usually managed by clinical engineers.

 Medical equipment is used for the specific purposes of

diagnosis and treatment of disease or rehabilitation following
disease or injury; it can be used either alone or in combination
with any accessory, consumable, or other piece of medical
equipment.

Medical equipment excludes implantable, disposable or single-

use medical devices.
 Concepts of “Essential Devices”

The concept of “Essential devices” is very much similar

To that of Essential Medicines. It promotes having a
limited range of carefully selected essential medicines
that satisfy the priority health care need of the population.
This is believed to lead to better health care, better drug
management, and lower costs. In the same manner, a
medical device should be considered essential only when
the following three criteria are fulfilled.
10/21/2023 Alem E. 7
1. Its use meets the basic needs of health services.

2. Proven to be cost-effective.

3. Evidence-based (i.e. follows well defined

specifications and widely accepted consensus by
experts).
The following factors must be included in the
consideration:
 Specific health services needs are met by acquiring
equipment.
 All equipment needs should be identified and
coasted, including any training of users and
servicing staff, physical facilities and auxiliary
supplies, such as water, electricity, air-
conditioning, protection and safety precautions..
 Spare parts and technical support from the local agent
must be ascertained.

 Supplier must provide both operation and service manuals.

 In evaluating tenders, quotations must be compared and

evaluated, not only in terms of price and delivery time, but
also in terms of availability and quality of back-up
support, spare parts and technical staff. Moreover, the
need to standardize must be considered so as to facilitate
the ease of use and maintenance.
 Classification of medical equipment
 Diagnostic equipment:- includes medical imaging
machines, used to aid in diagnosis. Examples: U/S,
MRI, CT scanners, and X-ray machines. Diagnostic
Medical Equipment may also be used in the home for
certain purposes, e.g. for the control of diabetes
mellitus

 Therapeutic equipment:- includes infusion pumps and

Medical lasers.
10/21/2023 Alem E. 11
• Life support equipment is used to maintain a patient's
bodily function. Includes medical ventilators, anaesthesia
machines, heart-lung machines, and dialysis machines

• Medical monitors allow medical staff to measure a

patient's medical state. Monitors may measure patient
vital signs and other parameters including
Electrocardiogram(ECG), Electroencephalogram (EEG),
blood pressure, and dissolved gases in the blood.
10/21/2023 Alem E. 12
• Medical laboratory equipment:- automates or helps
analyze blood, urine and genes.

• A biomedical equipment technician (BMET) is a vital

component of the healthcare delivery system.
Employed primarily by hospitals, BMETs are the
people responsible for maintaining a facility's medical
equipment.

10/21/2023 Alem E. 13
 Challenges in Technical - Specifications of Medical Equipment

A. Nomenclature System:- The same kind of a particular

medical equipment carries different nomenclature
system. For example:-

 Ultrasound machine is also called Sonography machine,

Doppler machine, Ultra-Sonography, USG machine etc.

 Vacuum aspirator is also named as suction machine,

vacuum pump, surgical aspirator etc.

10/21/2023 Alem E. 14
 Specification
 Function/purpose
Operational requirement
Technical specification : must be clear and comprehensive
Accessories, consumables , spare parts
Standards/safety
Environmental conditions
Power consumption
Documentation
After sales serving – installation, training, availability of spare parts
maintenance service in near by

Alem E. 15
 Medical equipment's Used in Surgery,
Anesthesia, Orthopedics,
Ophthalmology, Dentistry, ENT.

10/21/2023 Alem E. 16
 Operating Room Instruments

 Operating Room Instruments used in operating theatre for

operation purpose.

This include instruments like operating table,

suction apparatus, anesthetic machine, operating light,

autoclaves, defillibrator, etc.

10/21/2023 Alem E. 17
 Operating Table
• An operating table is a table on which a patient lies during a surgical
procedure. Sometimes known as a surgical table or operation table,
operating tables are typically used within an operating room or
surgical suite of a hospital,

ambulatory surgery center, or other healthcare facilities where

surgeries are performed.

• Operating tables may be either stationary or mobile to move room to

room. Operating tables are used in various types of procedures such a
cardiothoracic, orthopedic, bariatric,

Robotic urologic, and more

 Suction apparatus
Suction machine is used to remove mucus,

blood, and other bodily fluids from a patient.

They can be used during surgical procedures

but an Operating theater is generally

equipped with a central system of vacuum tube.

Most aspirators are therefore portable, for use in ambulances

and nursing homes.

10/21/2023 Alem E. 21
• Anesthesia machine: is a regulated medical device designed to
deliver known gases and vapors-Including Oxygen, and
anesthetic agents with a known concentration amounts.
primary sub-systems
• Gas Delivery
• Breathing
• Ventilator
• Scavenging
 Operating room light
• A surgical light – also referred to as an operating
light or surgical lighthead – is a medical device intended to assist medical
personnel during a surgical procedure by illuminating a local area or cavity
of the patient. A combination of several surgical lights is often referred to
as a “surgical light system”.

10/21/2023 Alem E. 24
Operating Room Autoclaves

• Autoclaves are used in medical applications to perform

sterilization .

• Many autoclaves are used to sterilize equipment and

supplies by subjecting them to pressurized saturated steam
at 121 °C (250 °F) for around 15–20 minutes depending on
the size of the load and the contents.
Defibrillator
An automated external defibrillator(AED) is a
portable electronic device that automatically diagnoses
the life-threatening cardiac arrhythmias of ventricular
fibrillation and pulseless ventricular tachycardia.

10/21/2023 Alem E. 27
 The application of electricity which stops the
arrhythmia, allowing the heart to re-establish an effective
rhythm. With simple audio and visual commands,

AEDs are designed to be simple to use for the layperson,

and the use of AEDs is taught in many first aid, certified
first responder, and basic life support (BLS) level
cardiopulmonary resuscitation (CPR) classes.

10/21/2023 Alem E. 28
 Ophthalmic Instruments:

Commonly called eye instruments

Examples include

• Slit lamp

• Operating microscope

• Auto-keratometer

10/21/2023 Alem E. 29
Auto-keratometer

• Auto-keratometer- An instrument used to measure

the curvature of the cornea.

• These measurements are frequently taken on patients

who are being fitted for contact lenses, measured for
intraocular lenses for cataract surgery, or who may
have corneal problems

10/21/2023 Alem E. 30
 Slit lamp
• A slit lamp microscope is an ophthalmic
instrument that uses a high-intensity light
that can be focused through a narrow slit to
illuminate the object being viewed under
the eyepiece and used for examination of
the cornea, aqueous humor, and retina of
the eye.

10/21/2023 Alem E. 31
• This kind of biomicroscope(microscope for
examining living tissue in the body) provides a three-
dimensional or stereoscopic view of the patient’s eyes
through a binocular eyepiece.

10/21/2023 Alem E. 32
10/21/2023 Alem E. 33
Ophthalmic operating microscope

• Ophthalmic operating microscopes are designed to

provide high contrast and detailed imaging of all
regions of the human eye.

10/21/2023 Alem E. 34
Ophthalmoscope

• The ophthalmoscope is used to view the back of

the eye, commonly called the fundus.

• This is the only place where arteries, veins, and

nerves can be seen without surgically entering
the patient.

• The effects of diabetes, hypertension, and

neurological problems can be detected and
followed with the ophthalmoscope
10/21/2023 Alem E. 35
 Dental Instruments
Dentistry instruments
• Dental Unit(complete with
dental chair, examination
light, ultrasonic scaler, )
• Hand held dental instruments
• Dental x-ray machine

10/21/2023 Alem E. 36
10/21/2023 Alem E. 37
Orthopedic instruments: Commonly called bone
instruments and include:
• Bone chisel
• Bone mallet
• Bone Cutter
• Bone holding forceps

10/21/2023 Alem E. 38
• Bone Chisel is commonly used by orthopedic surgeons to cut or
shape bone. Surgeons often use this instrument to obtain bone grafts in
procedures such as non-union fractures repair. Bone Chisel has a flat
round impaction platform with a solid octagonal handle, which provides a

firm handgrip.

10/21/2023 Alem E. 39
 Bone mallet
 Bone mallet handled hammers are used to drive a

chisel or wedge, or to strike a surface during a variety

of procedures .

10/21/2023 Alem E. 40
 Bone cutter
• A bone cutter is a surgical instrument used to cut or
remove bones.

10/21/2023 Alem E. 41
 Bone Holding Forceps
 Bone Holding Forceps are commonly used to
stabilize bones during repair. They may also be used
to remove bone fragments from a surgical site.

10/21/2023 Alem E. 42
 ENT Instruments
• Nasal scissors
• Aural speculum
• Tracheal dilating forceps
• Sinus forceps

10/21/2023 Alem E. 43
 Aural speculum

• A speculum is a duck-bill-shaped device that

doctors use to see inside a hollow part of your
body and diagnose or treat disease.

10/21/2023 Alem E. 44
 Tracheal Dilating forceps

• A surgical instrument or medical implement

used to induce dilation, that is, to expand an
opening or passage such as the cervix,
esophagus,

10/21/2023 Alem E. 45
 Sinus Forceps
• Sinus Forceps are commonly used for inserting
or removing packing in the sinus cavity.

10/21/2023 Alem E. 46
 Nasal scissors
 . With long blades and pointy tips, designed to cut
long, straight, smooth cuts in a variety of
materials, as well as to get into small areas with
the tips.

10/21/2023 Alem E. 47
 Otoscope

• The otoscope is used to view the tympanic

membrane and external ear canal to diagnose
outer and middle ear pathologies.

10/21/2023 Alem E. 48
Infection Control, Sterilization

and Care of Surgical

Instruments

10/21/2023 Alem E. 49
 A. Infection Control
• Infection control is the discipline concerned with
preventing healthcare-associated infection.

• Infection control addresses factors related to the

spread of infections within the health-care setting
(whether patient-to-patient, from patients to staff and
from staff to patients, or among-staff)

10/21/2023 Alem E. 50
 Technique of infection control
Ventilation of operation theatre

• The ventilating system has a very large part to play in

limiting infection. The temperature at 68 -70° F with a
humidity of 30-60 %. This reduces bacterial growth.

10/21/2023 Alem E. 51
 Aseptic technique
• Entering the theater with:
– Gowning

– Gloving

– Wear Eye or face shields should be worn during procedures that

are likely to generate blood droplets of blood or other body
fluids to prevent exposure of mucous membranes of the mouth,
nose and eyes.
– Cleaning the theater

– Decontamination of furniture and fixed equipment

10/21/2023 Alem E. 52
 • Sterilizing and disinfecting instruments

• Antiseptic solutions

• Boiling

• Hot air ovens

• autoclave

10/21/2023 Alem E. 53
B. Sterilization and Care of Surgical Instruments
• Surgical instruments may be damaged if used for
unintended purpose.

• Proper cleaning, handling and sterilization will ensure

surgical instrument perform as intended and extend
their useful life.

10/21/2023 Alem E. 54
 Care and Handling
Rinsing

• Immediately after surgery, rinse instruments under

warm (not hot) running water. Rinse should remove all
blood, body fluids and tissue.

Cleaning

• If not done immediately after rinsing, instruments

should be submerged in a solution of water and neutral
PH(7) detergent.
10/21/2023 Alem E. 55
 Sterilization and disinfection
• Sterilization is a process where by all microorganisms,
including heat resistant bacteria are removed or
destroyed.

• Disinfection is the process of removing or destroying

microorganisms to a level which is safe for some purpose
but not for all. With this method heat resistant spores
will not be destroyed.

10/21/2023 Alem E. 56
 I. Heat sterilization
A) Steam sterilization(autoclave)
• Widely used method for heat sterilization is the autoclave.

• To achieve sterility, a holding time of at least 15 minutes at

121 °C (250 °F) or 3 minutes at 134 °C (273 °F) is required.

• It is suitable for sterilizing metal instruments and appliances,

various kinds of heat resistant glass items, syringes, gauze….

10/21/2023 Alem E. 57
• Steam sterilization requires four conditions in order
to be efficient:

 adequate contact,

Sufficiently high temp.

Correct time and

Sufficient moisture.

10/21/2023 Alem E. 58
B) Dry heat (In an oven).

• Dry heat sterilization is performed at 170 C (340 F) for

1hr or 2 hrs at a temperature of 160 C (320 F). Dry heat
sterilization can also be performed at 121 C, for at least
16 hours.

• It can only be used to disinfect instruments that are made

of metal or glass because of the high temperature.

10/21/2023 Alem E. 59
 II. Chemical sterilization
Also referred to as cold sterilization, can be used to
sterilize instruments that cannot normally be disinfected
through the other two processes described above.

A) Ethylene oxide

• Ethylene oxide gas is commonly used to sterilize

objects sensitive to temperatures greater than 60 °C and
/ or radiation such as plastics and optics.

10/21/2023 Alem E. 60
• Ethylene oxide treatment is generally carried out between
30 °C and 60 °C with relative humidity above 30% and a
gas concentration between 200 and 800 mg/l, and
typically lasts for at least 3 hrs.

• It can kill all known viruses, bacteria and fungi, and is

compatible with most materials (e.g. of medical devices).

Precaution: it is highly flammable, toxic and carcinogenic.

10/21/2023 Alem E. 61
B) Glutaraldehyde and formaldehyde

• Glutaraldehyde and formaldehyde solutions are accepted

liquid sterilizing agents, provided that the immersion time
is sufficiently long.

C) Hydrogen peroxide

• H2O2 is another chemical sterilizing agent. It is relatively

non-toxic when diluted to low concentrations, such as the
familiar 3% retail solutions although hydrogen peroxide is
a dangerous oxidizer at high concentrations (> 10% w/w).
10/21/2023 Alem E. 62
 Other Methods
Reading assignment

• Flaming

• Incineration

• Boiling in water

• Tindalization

• Radiation sterilization

10/21/2023 Alem E. 63
After cleaning and sterilization

• Any instruments are to be stored, let them air dry and

store them in a clean and dry environment.

10/21/2023 Alem E. 64
 Diagnostic Instruments and Reagents

10/21/2023 Alem E. 65
 Different diagnostic Equipment
A. Laryngoscope:- Is equipment that is used to obtain a
view of the vocal folds and the glottis.

10/21/2023 Alem E. 66
B. Stethoscope
• Is an acoustic medical device for auscultation, or
listening to the internal sounds of an animal body. It is
often used to listen to lung and heart sounds.
• It is also used to listen to intestines and blood flow in
arteries and veins.
• In combination with a sphygmomanometer, it is
commonly used for measurements of blood pressure.
10/21/2023 Alem E. 67
 Stethoscope
A simple stethoscope usually
consists of a diaphragm(for
identifying high-pitched
sounds) or an open bell(best
for listening to low-pitched
sounds).

10/21/2023 Alem E. 68
 Sphygmomanometer
• An instrument for measuring blood pressure, typically
consisting of an inflatable rubber cuff which is applied to the
arm and connected to a column of mercury next to a graduated
scale, enabling the determination of systolic and diastolic
blood pressure by increasing and gradually releasing the
pressure in the cuff.

10/21/2023 Alem E. 69
• The cuff is normally placed around an upper arm, at
roughly the same vertical height as the heart while
the subject is seated. The cuff is inflated until the
artery is completely occluded.
• The pressure at which the first sound began is noted
and recorded as the systolic blood pressure. The cuff
pressure is further released until the sound can no
longer be heard. This is recorded as the diastolic blood
pressure.
10/21/2023 Alem E. 70
 Sphygmomanometer

10/21/2023 Alem E. 71
D .Medical thermometer
• Medical thermometers are used for measuring human body
temperature, with the tip of the thermometer being inserted
either into the mouth under the tongue (oral or sub-lingual
temperature), under the armpit (axillary temperature), or into
the rectum via the anus (rectal temperature).

10/21/2023 Alem E. 72
E .Glucose meter

• A glucose meter (or glucometer) is a medical device for

determining the approximate concentration of glucose in
the blood. It is a key element of home blood glucose
monitoring by people with diabetes mellitus or
hypoglycemia.
• A small drop of blood, obtained by pricking the skin with a
lancet, is placed on a disposable test strip that the meter reads
and uses to calculate the blood glucose level. The meter then
displays the level in mg/dl or mmol/l.
10/21/2023 Alem E. 73
 Medical Imaging Equipment

10/21/2023 Alem E. 74
 Medical Imaging Equipment

• Medical imaging is the technique and process used to

create images of the human body (or parts and
function thereof) for clinical purposes (medical
procedures seeking to reveal, diagnose or
examine disease) or medical science (including the
study of normal anatomy and physiology).

10/21/2023 Alem E. 75
 Ultrasound
• Ultrasound is an oscillating sound pressure wave with a
frequency greater than the upper limit of the human hearing
range.
• Ultrasound is thus not separated from 'normal' (audible) sound
based on differences in physical properties, only the fact that
humans cannot hear it.
• Although this limit varies from person to person, it is
approximately 20 kilohertz (20,000 hertz) in healthy, young
adults. Ultrasound devices operate with frequencies from
20 kHz up to several gigahertz.
10/21/2023 Alem E. 76
10/21/2023 Alem E. 77
Medical sonography
(ultrasonography) is an
ultrasound-based diagnostic
medical imaging technique used
to visualize muscles, tendons, and
Many internal organs, to capture
their size, structure and any
pathological lesions with real time
tomographic images.

10/21/2023 Alem E. 78
 Ultrasound in Obstetrics and Gynecology
• Ultrasound is extensively used in obstetrics and
gynecology as a safe, non-invasive, accurate, and cost
effective tool to look at the fetus.
• No set number of scans, but recommended that normally
the woman have 2 to 3.
• 1st scan at 7 weeks:- confirm pregnancy, exclude ectopic
or molar pregnancies, confirm cardiac pulsation, and
measure the crown-rump length for dating.
10/21/2023 Alem E. 79
 • 2nd scan at 18-20 weeks: look for congenital
malformations, exclude multiple pregnancies, verify
dates and growth, placental position (or at 13-14
weeks to diagnose Down Syndrome).
• 3rd scan at 34 weeks: evaluate fetal size and assess
fetal growth, verify fetal position

10/21/2023 Alem E. 80
 Magnetic Resonance Imaging (MRI)
• Magnetic Resonance Imaging • MRI makes use of the property

(MRI), Nuclear magnetic of nuclear magnetic resonance

resonance imaging (NMRI), or (NMR) to image nuclei of

Magnetic resonance atoms inside the body

tomography (MRT) is a
medical imaging technique
used in radiology to visualize
internal structures of the body
in detail..
10/21/2023 Alem E. 81
• Allows the clinician to see high quality images of the
inside of the body:
Brain
 Heart
 Lungs
 Spine
 Knees
 Wrist
 Etc.
• MRI is also used a great deal in basic science to study brain
function and cancer growth

10/21/2023 Alem E. 82
MRI’s of the heart can be done to look at many different areas
including: vessels, chambers, and valves.

The MRI can detect problems

associated with different heart diseases
including plaque build up and other
blockages in blood vessels due to
coronary artery disease or heart
attacks.

10/21/2023 Alem E. 83
 MRI’s of the brain can
evaluate how the brain is
working, whether normal or
abnormal.

 Brain MRI’s can show damage resulting from different problems

such as: damage due to stroke, abnormalities associated with
dementia and/or Alzheimer’s, seizures, and tumors.

MRI are done prior to brain surgery, to give a

map of the brain, and help plan the procedure.

10/21/2023 Alem E. 84
MRI’s can be done on the Often prior to a MRI scan, a
knee to evaluate damage to patient would need to have a
the meniscus, ligaments, and contrast dye, either injected
tendons. or taken orally, usually
gadolinium as seen here

10/21/2023 Alem E. 85
 Procedure – MRI
 Once the contrast dye has been injected, the patient enters the bore

of the MRI machine on their back lying on a special table.

 The patient will enter the machine head first or feet first, depending
on the area to be scanned. The scan can last anywhere from 20-30
minutes.

10/21/2023 Alem E. 86
• The patient must hold completely still in order to get a
high quality image. (This is hard for patients with
claustrophobia, and often times a sedative will be
given, if appropriate.

10/21/2023 Alem E. 87
The MRI has allowed clinicians to treat, monitor, and
learn about many different diseases and problems. As
well as, to learn how the body functions, normally,
without needing to resort to more invasive methods like
surgery.

10/21/2023 Alem E. 88
 MRI treatment is a wonderful option for most patients, but
there are some people who are not candidates. Those
include:-
1. Patients with pacemakers cannot have the scan done as the
magnet from the MRI interferes with the signal sent from
the pacemaker, and deactivates it.
2. Patients who are too tall, or too obese

3. Patients who have orthopedic hardware can get distortion

in the image, and the scan quality is not as high.

10/21/2023 Alem E. 89
 Scanning System(CT scan)
 X-ray computed tomography, also computed tomography (CT
scan) or computed axial tomography (CAT scan), is a medical
imaging procedure that utilizes computer-processed X-rays to
produce tomographic images or 'slices' of specific areas of the
body. These cross-sectional images are used for diagnostic and
therapeutic purposes in various medical disciplines.

10/21/2023 Alem E. 90
 CT Scanner

 Used to determine:
 extent of trauma
 location and type of
tumors
 status of blood vessels
 pre surgical planning

10/21/2023 Alem E. 91
 General Diagnostic applications
 Head
 CT scanning of the head is typically used to detect
infarction, tumors, calcifications, hemorrhage and
bone trauma.
 Lungs
 CT can be used for detecting both acute and chronic
changes in the lung parenchyma, that is, the internals
of the lungs.
10/21/2023 Alem E. 92
Pulmonary angiogram ,.Contd
 CT pulmonary angiogram (CTPA) is a medical

diagnostic test used to diagnose pulmonary embolism

(PE). It employs computed tomography and an iodine
based contrast agent to obtain an image of the
pulmonary arteries.
Cardiac
 CT allowing excellent imaging of the coronary
arteries (cardiac CT angiography).

10/21/2023 Alem E. 93
Abdominal and pelvic
 CT is a sensitive method for diagnosis of abdominal diseases.
It is used frequently to determine stage of cancer and to follow
progress. It is also a useful test to investigate acute abdominal
pain.
In Extremities
 CT is often used to image complex fractures, especially ones
around joints, because of its ability to reconstruct the area of
interest in multiple planes. Fractures, ligamentous injuries and
dislocations can easily be recognised.

10/21/2023 Alem E. 94
 CT versus MRI

• CT scan is the preferred modality for cancer, pneumonia, and

abnormal chest x-rays.

• Bleeding in the brain, especially from injury, is better seen on

CT than MRI. But a tumor in the brain is better seen on MRI.

• If you've been in an accident, organs can get torn or damaged.

CT shows organ tear and organ injury quickly and efficiently.

10/21/2023 Alem E. 95
• Broken bones and vertebral bodies of the spine are
better seen on CT but injury to the spinal cord itself is
displayed on MRI far better than CT.
• CT is far superior at visualizing the lungs and organs
in the chest cavity between the lungs.
• MRI is not a good tool for visualizing the chest or
lungs at all.

10/21/2023 Alem E. 96
 Mammography unit
 Other common names:- Mammo units; X-ray system,
diagnostic, mammographic, stationary, digital
 Intended use : Mammographic radiographic units use x-rays to produce
images of the breast—a mammogram—that provide information about
beast morphology, normal anatomy, and gross pathology. Mammography is
used primarily to detect and diagnose breast cancer and to evaluate
palpable masses and no palpable breast lesions
 Principles of operation
 Low energy X-rays are produced by the x-ray tube (an evacuated
 tube with an anode and a cathode) when a stream of electrons,
 accelerated to high velocities by a high-voltage supply from the
 generator, collides with the tube’s target anode. The cathode
contains
 a wire filament that, when heated, provides the electron source.
 The target anode is struck by the impinging electrons. X-rays
exit the tube through a port window of beryllium.
 Additional filters are placed in the path of the x-ray beam to
modify the x-ray spectrum.
• User(s): Radiology/mammography technican, radiologist
Technical specification & Standard
 High frequency generator
 kV range at least 22–35 kV with 1 kV increments
 mA range up to at least 100 mA
 Time range at least 0.05–86sec
 mAs range at least 5–500 mAs
 Automatic exposure control
 X-ray Tube
 rotating anode
 heat capacity at least 300,000 HU
 heat dissipation rate at least 60,000 HU/min
 target/filter Mo/Mo, Mo/Rh
 dual focus 0.1/0.3 mm
 Breast compression system with automatic, manual and fine adjustment
 Grid ratio 5:1
 Radiation shield with lead glass as required
Technical specification for Mammography Machine for Breast
X-Rays.
 Compatibility of Digital Stereotactic Biopsy Device.
 Around 3.5 KW High frequency X-Ray Generator.
 Automatic Exposure Control (AEC) Rhodium Filter.
 Rotating Anode Dual Focus X-Ray Tube of Focal
0.1/0.3 mm.
 Motorized Breast Compression with Digital Display
 KV : 22 to 35 KV./ describe
 MAS : 1 to 700 MAS./ describe
 Power Supply: 220V, AC, 50 Hz., Single Phase
 Monitor, Bedside, Electroencephalography
Other common names:- Cerebral function monitors; EEG recorders;

electroencephalographs; monitors, bedside, electroencephalography,

spectral.
• Intended use:- EEG monitors are used for observing and
diagnosing a variety of neurologic conditions, including
epilepsy, related convulsive disorders, and brain death. They
can also be used to evaluate psychiatric disorders and
differentiate among various psychiatric and neurologic
conditions. In addition, electroencephalographic studies with
EEG monitors can assist in localizing tumors or lesions on or
near the surface of the brain
• User(s): Neurologists, neurosurgeons, or other physicians,
EEG technicians, sleep lab technicians

10/21/2023 Alem E. 102

 Electrosurgical Unit
• Other common names:- Bovies; Coagulators, Electrosurgical;
Diathermy Units, Surgical; Electrocautery Units; Electrosurgical
Generators; Endometrial Ablation Systems; ESUs; Hyfrecators;
Malis Coagulators; Stimulators, Muscle; Surgical Diathermy
Units; Surgical Units; Wapplers; Apparatus, electrosurgical;
Surgical diathermy generator

10/21/2023 Alem E. 103

• Intended use;- Devices intended for surgical cutting
and for controlling bleeding by causing coagulation
(homeostasis) at the surgical site. Electro surgery is
commonly used in dermatological, gynecological,
cardiac, plastic, ocular, spine, ENT, maxillofacial,
orthopedic, urological, neuro- and general surgical
procedures as well as certain dental procedures.

10/21/2023 Alem E. 104

• Principles of operation:- In monopolar electrosurgery,
tissue is cut and coagulated by completion of an
electrical circuit that includes a highfrequency
oscillator and amplifiers within the ESU, the patient,
the connecting cables, and the electrodes. In most
applications, electric current from the ESU is
conducted through the surgical site with an active cable
and electrode.

10/21/2023 Alem E. 105

• The electrosurgical current exits the patient through a
dispersive electrode (usually placed on the patient at a
site remote from the surgical site) and its associated
cable connected to the neutral side of the generator.

10/21/2023 Alem E. 106

 Technical specification of Electrosurgical Unit
(Monopolar-bipolar
Outputs of cut, coagulate and blend Maximum output 300 W for monopolar cut
Activation :
• Double pedal switch which may be used for the monopolar and bipolar
functions .
• Hand-switch handle
• Bipolar electrode with pedal switch or with automatic Start/Stop system ( for
• coagulation only)
Control
• The Unit shall stop automatically in case of internal error which shall be
identified on
• Display and with audible alarm
• Memorization : User shall be able to use at least 4 working programs

10/21/2023 Alem E. 107

Safety :-
• Neutral plate safety circuit shall control connections and
contacts of Neutral Plate with Tissues:
• Defective Contact shall be notified with visual Alarm and
immediate reducing of power
• Output circuit : floating - protected against defibrillator
interferences . Shall have HF
• leakages less than 150mA through each electrode
• Power Supply : 220VAC, 50Hz
• Cooling: convection without fan
• HF electrosurgical unit shall be used to execute monopolar
and bipolar surgery in many fields of application where high
precision and reliability are essential

10/21/2023 Alem E. 108

• Accessories :
 Single-use two button Handle , Autoclavable
 Handle shall be provided with a 3 Pins socket that shall fit majority of bipolar
electrosurgical units
 Operative Foot-switch (usable as alternative to handle)
 Reusable neutral Plate
 Kit of 10 short autoclavable Electrodes
 Electrode wire - straight
 Electrode wire - angled 45°
 Electrode bend - 0 4 - straight
 Electrode bend - 0 8 - straight
 Electrode hook - angled 45°
 Electrode wire 1 mm.- angled 45°
 Electrode straight slip-knot - straight
 Electrode angled slip-knot - straight
 Electrode ball point - 0 3 mm. - angled 45°
 Electrode ball point - 0 3 mm. – straight
 Bipolar Forceps : 6
 Forceps shall be provided

10/21/2023 Alem E. 109

Forceps shall be provided with a standard European connection
 Straight Forceps - 18 cm. (7")
 Curved Forceps - 18 cm. (7")
 Curved Forceps - 20 cm. (7 3/4")
 Bayonet Forceps - 18 cm. (7")
 Bayonet Forceps - 20 cm. (7 3/4")
 Straight Forceps - 20 cm. (7 3/4")
 Cable, Bipolar
 Adaptor, Bipolar Cable
 User Manual
Standards : EC Marked, US FDA; ISO certification

10/21/2023 Alem E. 110

 Electrocardiograph, ECG
Other common names:- Computer-assisted electrocardiographs;
interpretive ECG machines; interpretive electrocardiographs;
automated electrocardiographs; EKG machines;
Electrocardiograph multichannel;

10/21/2023 Alem E. 111

Intended use:- Electrocardiographs detect the electrical
signals associated with cardiac activity and produce an
ECG, a graphic record of the voltage versus time. They
are used to diagnose and assist in treating some types of
heart disease and arrhythmias, determine a patient’s
response to drug therapy, and reveal trends or changes
in heart function.

10/21/2023 Alem E. 112

 Colonoscope
Other common names:- Endoscopes; video endoscopes; Video
colonoscope, flexible.

10/21/2023 Alem E. 113

• Intended use:- Colonoscopes are used for the removal
of foreign bodies, excision of tumors or colorectal
polyps and control of hemorrhage.
• Routine colonoscopy is important in diagnosing
intestinal cancer, the second leading cause of cancer
deaths in the United States. These endoscopic
procedures reduce the need for invasive surgical
diagnostic and therapeutic procedures.

10/21/2023 Alem E. 114

 Life Support Equipment

 Medical ventilators,
 Heart - Lung machines,
 ECMO (Extracorporeal membrane oxygenation),
 Dialysis machines
 Medical ventilators
• A medical ventilator (or simply ventilator in context) is a
machine designed to mechanically move breatheable air in and
out of the lungs, to provide the mechanism of breathing for a
patient who is physically unable to breathe, or breathing
insufficiently.
• Ventilators are commonly used in intensive care medicine, home
care, and in anesthesia (as a component of an anesthesia
machine).
• Medical ventilators are sometimes colloquially called
"respirators,"
 How Does a Ventilator Work?

• Ventilators blow air or air with extra oxygen into the airways
and then the lungs. The airways are pipes that carry oxygen-
rich air to your lungs. They also carry carbon dioxide, a waste
gas, out of your lungs. The airways include your:
• Nose and linked air passages, called nasal cavities
• Mouth
• Larynx or voice box
• Trachea or windpipe
• Tubes called bronchial tubes or bronchi.
 Heart - Lung machines
• Cardiopulmonary bypass (CPB) is a technique that
temporarily takes over the function of
the heart and lungs during surgery, maintaining the
circulation of blood and the oxygen content of the
body.
• The CPB pump itself is often referred to as a
"Heart - lung machine" or "the pump". CPB is a form
of extracorporeal circulation.
How it works?
 Uses of cardiopulmonary bypass

• Cardiopulmonary bypass is commonly used in heart

surgery because of the difficulty of operating on the beating
heart.
• Operations requiring the opening of the chambers of the heart
require the use of CPB to support the circulation during that
period.
• The machine nourishes the blood cells and allows them to
continue cellular respiration even through surgery.
• If blood flow is stopped at normal body temperature,
permanent brain damage normally occurs in three to four
minutes — death may follow shortly afterward. Similarly,
CPB can be used to rewarm individuals suffering from
hypothermia.
• Extracorporeal membrane oxygenation (ECMO) is a
simplified form of CPB sometimes used as life-support for
newborns with serious birth defects, or to oxygenate and
maintain recipients for organ transplantation until new organs
can be found.
 ECMO
• In intensive care medicine, extracorporeal membrane
oxygenation (ECMO) is an extracorporeal technique of
providing both cardiac and respiratory support oxygen to
patients whose heart and lungs are so severely diseased or
damaged that they can no longer serve their function. Initial
cannulation of a patient receiving ECMO is performed by
a surgeon and maintenance of the patient is the responsibility
of the ECMO Specialist and gives 24/7 monitoring care for the

duration of the ECMO treatment.

 Uses:
• ECMO use on cadavers can increase the capability rate
of transplanted organs.
• Applications for ECMO may expand in the future to include
percutaneous temporary left ventricular assistance and low
flow ECMO for CO2 removal.

• In addition, new technologies will improve the simplicity and

safety of ECMO, including new oxygenators, pumps, and
surface coatings.
Differences between ECMO and Cardiopulmonary
bypass
• ECMO is frequently instituted using only cervical cannulation,
which can be performed under local anesthesia; standard
cardiopulmonary bypass is usually instituted by transthoracic
cannulation under general anesthesia
• Unlike standard cardiopulmonary bypass, which is used for short-
term support measured in hours, ECMO is used for longer-term
support ranging from 3-10 days
• The purpose of ECMO is to allow time for intrinsic recovery of the
lungs and heart; a standard cardiopulmonary bypass provides
support during various types of cardiac surgical procedures.
 Dialysis
• In medicine dialysis is a process for removing waste and
excess water from the blood, and is used primarily to provide
an artificial replacement for lost kidney function in people
with renal failure.
• Dialysis may be used for those with an acute disturbance in
kidney function. (Mostly in acute kidney injury, previously
acute renal failure & chronic renal failure or end-stage renal
disease)
• Kidneys maintain the body's internal equilibrium of water and
minerals (sodium, potassium, chloride, calcium, phosphorus,
magnesium, sulfate).
• The kidneys also function as a part of the endocrine system,
producing erythropoietin (RBC) and calcitriol (Bone
formation).
• Dialysis is an imperfect treatment to replace kidney function
because it does not correct the compromised endocrine
functions of the kidney.
• Dialysis treatments replace some of these functions through
diffusion (waste removal) and ultrafiltration (fluid removal).
Dialysis machines
 Diagnostic Imaging Drugs

10/21/2023 Alem E. 131

 X-Ray imaging
 X-Ray imaging is used in diagnosing muscle and
bone disorders, locating blood clots, detecting
internal bleeding, monitoring diseases such as cancer

10/21/2023 Alem E. 132

• To enhance imaging patients are given laxatives,
enemas, or suppositories.
• Agents serving to increase contrast by weakening or
blocking x-ray transmission include…
– Barium (Ba)

– Barium Sulphate (BaSO4)

– Iodine (I)
– Gastrograffin
10/21/2023 Alem E. 133
Ultrasound imaging:
• Ultrasound agent are administered IV to increase the
reflectivity of blood and act as echo-enhancing agents
because they increase the radio frequency signal
received by the transducer in the ultrasound unit.
• polybutyl-2 cyanoacrylate has been shown to work in
this cases

10/21/2023 Alem E. 134

Magnetic Resonance contrast agent
• The majority of Magnetic Resonance contrast agents
are gadolinium chelates. These compounds cross the
intact BBB making them important drug for
evaluating the brain.
• Gadolinium, a lanthide metal, is relatively inert and
produce few adverse effect.

10/21/2023 Alem E. 135

 Non-imaging in vivo diagnostic drugs

 Drugs in this category are listed below on the

physiological system to be evaluated.

10/21/2023 Alem E. 136

 Cardiovascular system
Adenosine:
• An endogenous nucleoside that is present in all cells
of the body. It is a potent peripheral vasodilator
used during myocardial perfusion stress in patients
who are unable to exercise.
• It produces a more reliable and more potent
vasodilation than dipyramidole.

10/21/2023 Alem E. 137

 CVS…..
Dipyridamole:
• A vasodilator used during myocardial perfusion
stress scintigraphy as an alternative to exercise in
patients who cannot exercise adequately when it is
administered intravenously.
• Dipyridamole indirectly increases endogenous
adenosine by blocking uptake and/or by inhibiting the
enzyme adenosine deaminase
10/21/2023 Alem E.
and phosphodiesterase.138
Dobutamine:
• Dobutamine is a sympathomimetic amine that produce
inotrophic and chronotrophic effects in the heart. It is
used during myocardial perfusion stress scintigraphy in
patients who can’t exercise.
• It is only used when adenosine or dipyridamole cannot be
used because of dobutamine’s severe adverse effects.
• These effects include chest pain, ST-T segment ECG
changes,, headache and dyspnea .

10/21/2023 Alem E. 139

 Endocrine system
Adrenal gland function:-
• Corticotrophins(ACTH) are used to diagnose adrenocortical
insufficiency.
• Cosyntropin may be preferred and/or used as a screening
test because:
– it has a lower incidence of allergic or sensitivity reactions
– can provide a result within 30 minutes.
• For a definitive diagnosis, the 24-hour infusion test using
corticotropin test is required.
10/21/2023 Alem E. 140
Pheochromocytoma diagnosis:
• The overproduction & secretion of catecholamine's from tumors
found most often in the adrenal medulla are diagnosed by
collecting a 24-hour urine sample and measurement of free or
metabolized catecholamine's.
• When the results of this test are equivocal, either clonidine or
glucagon may act as aids in the diagnosis.
• Clonidine: Clonidine normally suppresses catecholamine's level
in the plasma, but has little effect in patients with
pheochromocytoma.
10/21/2023 Alem E. 141
Pancreatic gland function:
• The pancreas has both an endocrine and exocrine
function. Pancreatic exocrine function tests are
described in the gastrointestinal section. An oral
glucose tolerance test is used to diagnose diabetes
mellitus.
• Tolbutamide sodium: A single intravenous dose of
tolbutamide sodium is useful in the diagnosis of
functioning insulinomas.
10/21/2023 Alem E. 142
Parathyroid function:
 Teriparatide acetate:

• It is used to distinguish between hypocalcemia due to

hypoparathyroidism and pseudo- hypoparathyroidism.

10/21/2023 Alem E. 143

Pituitary function:
1.Arginine hydrochloride:
• Intravenous infusion of arginine Hcl stimulates the
release of growth hormone in patients with competent
pituitary function.

10/21/2023 Alem E. 144

 2. Corticorelin ovine trifluate: (Acthrel)
• Approved as an orphan drug for differentiating
between the pituitary gland and ectopic sources of
production of ACTH in patients who have ACTH –
dependent cushing’s syndrome.
• Patients who have primary cushing’s syndrome
experience a rise in plasma ACTH and cortisol, whereas
patient who have ectopic sources of ACTH do not.

10/21/2023 Alem E. 145

Thyroid function:
 Protirelin

• An adjunct in the diagnostic assessment of thyroid

function and pituitary or hypothalamic dysfunction.
It is a synthetic tripeptide believed to be structurally
identical to the naturally occurring thyrotropin-
releasing hormone produced by the hypothalamus.

10/21/2023 Alem E. 146

 Gastrointestinal Tract
Gall bladder
 Sincalide
• A synthetic fragment of cholecystokinin that stimulates
contraction of the gallbladder and increases intestinal motility.
• It is used frequently during imaging studies such as
cholecystography or ultrasonography to stimulate the gall bladder
to contract and release bile instead of a fatty meals because of its
fast action, usually 5 to 15 minutes.
Other uses
• to obtain a specimen of gall bladder bile for analysis.
• to increase movement of barium sulfate through the intestine
fluoroscopy.
10/21/2023 Alem E. 147
Stomach:
 Gastric acid test

• The presence of HCl is useful in the diagnosis of certain

peptic ulcer conditions.
• The gastric stimulant used for this purpose is pentagastrin.

Pentagastrin
• A diagnostic agent used to evaluate gastric acid secretory
function.

10/21/2023 Alem E. 148

 Lymphatic system
 Isosulfan blue

• An adjunct to lymphography for visualization of

the lymphatic system draining the area in which it is
injected.
NB:-It has no known pharmacological action.

10/21/2023 Alem E. 149

 Reproductive system

 Dextran 70 (32 % w/v) in Dextrose (10% w/v)

• Intended for use of an aid with the hysteroscope in

the
– distention of the uterine cavity and
– in irrigating and
– visualizing its surfaces.

10/21/2023 Alem E. 150

 Ophthalmic diagnostic aids
 Fluorescin sodium

• Used as
– a sterile ophthalmic strip impregnated with drug,
– an aqueous solution for the diagnosis of corneal
lesions, and
– the detection of minute foreign bodies embedded
in the cornea.

10/21/2023 Alem E. 151

 Urinary system
Kidney function
• measurement of creatinine clearance is used to evaluate
the status of kidney function. However, certain aspects
of renal function can be accurately determined by the
use of other drugs.
• GFR can be measured by the renal plasma clearance of
inulin, thiosulfate, mannitol or endogenous creatinine.

10/21/2023 Alem E. 152

 4-Medical Laboratory Equipments
Laboratory instruments can be categorized as
♠ Hematology instruments , eg. Hematology analyser, hemoglobin
meter
♠ Immunological instruments eg. Centrifuges, ELISA reader (also
known as an enzyme immunoassay (EIA), is a biochemical
technique used mainlyin immunology to detect the presence of
an antibody or an antigen in a sample), incubators

10/21/2023 Alem E. 153

♠ Hormone Analysis instruments- eg. ELISA washer, centrifuge,

♠ Urinalysis instruments- Microscope, centrifuges

♠ Clinical Chemistry- eg. Chemistry analyser, centrifuges,

electrolyte analyser

♠ Histological instrument-eg. Tissue processors(for fixing,

dehydrating, clearing and paraffin impregnating ), water bath,

Microtome

♠ Medical Research/referal laboratory instruments e.g

Biological safety cabinet in TB lab

10/21/2023 Alem E. 154
 Microscope

• A microscope is an instrument that uses a lens or a

combination of lenses to magnify and resolve the
fine details of an object.
• Have Optical System (objective lens, eye piece) and
Mechanical System(base, arm, Stage, body tube,
coarse adjustment, fine adjustment)

10/21/2023 Alem E. 155

10/21/2023 Alem E. 156
 Centrifuge
• Centrifuge: a motor-driven machine
used in laboratories to separate
components, or to alter the local
distribution of components of a
system by means of centrifugal
acceleration in rapidly rotating
vessels/tubes

10/21/2023 Alem E. 157

 Incubators
• Most incubators are used to
provide a controlled
temperature (and sometimes a
controlled humidity. Usually, this
is about body temperature, 37oC,
through a thermostat. This is the
most suitable temperature for most
bacteria in culture media.
10/21/2023 Alem E. 158
• An incubator comprises a transparent chamber and
the equipment that regulates its temperature, humidity

, and ventilation.

10/21/2023 Alem E. 159

 Spectrophotometer
• An instrument which can
measure the absorbance of a
sample at any wavelength.

10/21/2023 Alem E. 160

 Biological Safety cabinet
• A biological safety cabinet is a ventilated
cabinet which uses a variety of
combinations of HEPA(High Efficiency
Particulate Air) filtration, laminar air flow
and containment to provide either
personnel, product or environmental
protection or protection of all components
against particulates or aerosols from
biohazards agents.
10/21/2023 Alem E. 161
 Reading assignment
Medical Reagents Used in the Medical
Laboratory

10/21/2023 Alem E. 162

Definition
• Reagents are chemicals and biological that are used in
laboratory testing for detecting or measuring an
analayte.

• Reagents vary widely in cost, stability, storage

conditions requirements, availability, and the hazards
associated with each one of them.

• They are further classified into liquid and solid.

10/21/2023 Alem E. 163

 Hematologic tests

• Typical hematologic tests include Complete blood

count, White blood cells, and platelets.

• Other tests include examination of blood film for

differential WBC count and red cell morphology

10/21/2023 Alem E. 164

1. Complete blood count(CBC)

• Includes TLC, DLC, RBC count, Hgb, Hct and platlets.

A. Total white blood cell(WBC)

• It is mostly helpful in diagnosis of infectious disease.

• It estimates the total number of white cells in cubic mm

of a blood.

10/21/2023 Alem E. 165

• Reagents
• Turks solution
• Glacial acetic acid
• 1% aq solution of gentain violet
• Distilled water
• 1N hydrochloric acid

10/21/2023 Alem E. 166

B. Platelet count

• Reagents required
• Diluting fluids
• Ammonium oxalate solution(1)
• Distilled water
• Rees- ecker method
• Trisodium citrate
• Neutral formaldehyde
• Brilliant cresyl blue distilled water
10/21/2023 Alem E. 167
C. Differential WBC: also aids the dx of different
infectious disease.
• Reagents: romanosky stains
D. Red blood cells(RBC) count
• Diluting fluid: should be isotonic to prevent hemolysis.
• Sodium citrate (1)
• Formalin
• Distilled water
• hayem’s fluid(2)
• Mercuric chloride
• Sodium chloride
• Sodium sulphate
• Distilled water
10/21/2023 Alem E. 168
E. Measurement of Hemoglobin(Hb)

• measurement of hgb is used to diagnose anemia.

• The commonest methods to measure Hb in blood are

acidhaematin(sahali) and cyanomethaemoglobin.

10/21/2023 Alem E. 169

I. Acidhaematin method(dsahali method)

• This is a visual method of hemoglobin estimation

and it is applied in laboratories where there is no
photometer.

• Sahali hemoglobinometer consisting of comparater(

glass strands) and sahali graduated tube.

• 0.1N HCL

10/21/2023 Alem E. 170

II. Cyanomethaemoglobin method: it is colorimetric
method where a commercial cyanomethaemoglobin
standard is used for comparison.

• Reagents: drab kin’s solution

• Potassium cyanide

• Potassium ferricyanide

• Potassium dihydrogen phosphate

• Distilled water
10/21/2023 Alem E. 171
• Cyanometheamoglobin standard available
commercially in sealed ampoules

• Photometer

N.B. drab kin’s solution is light sensitive reagents so

that it must be stored in brown bottle.

10/21/2023 Alem E. 172

F. Examination of red cell morphology: red cell
morphology also aids in dx of anemia.

• Reagents
• Romanosky stain( giemsa/ wright stain)

10/21/2023 Alem E. 173

 2. Erythrocyte Sedimentation rate(ESR)

• ESR is rate at which erythrocyte sediment when

anti- coagulant blood is held in a vertical tube.

• There are two methods to determine ESR

• I. Westreggreen’s method
• II. Wintrob’s method

10/21/2023 Alem E. 174

I. Westergreen’s method

• Westergreen’s pipette: it is open at both ends and about

30cm long with internal diameter of 2.5mm.

• The pipette has graduation of 0 to 100mm and a

capacity about 1ml of blood.

• Tri sodium citrate(3.8%)- anti-coagulant

10/21/2023 Alem E. 175

II. Wintrobe’s method

• Wintrobe’s: is graduated 11cm long tube with

internal diameter of 2.5mm

• Tri-sodium citrate(3.8%)

10/21/2023 Alem E. 176

3. Assesment of cloting system

a. Prothrombin time: this test measures the extrinsic

pathway of coagulation.

Reagents

• Thromboplastin

• 0.025M calcuim chloride

• Anticoagulat( tri sodium citrate)

10/21/2023 Alem E. 177
B. Activated partial thromboplastin time(APTT): the
test demonstrates deficiencies within the intrinsic
pathway and the final common pathway.

Reagents

• Kaolin- suspend 0.5g kaolin in 100ml saline

• Phospholipids

• 0.025M calcium chloride

10/21/2023 Alem E. 178

 4. Immunological/serological tests

• Immunological tests can be used in the dx of bacterial,

viral, fungal and parasitic infectious disease.

A. ABO grouping

• Determination of ABO group is necessary both for the

donor as well as the recipient in blood transfusion.

• Reagents

• ABO grouping antisera: anti A, anti-B anti-D antiserum

10/21/2023 Alem E. 179
B. Venereal disease research laboratory(VDRL) test

• it is non specific test used for the dx of syphilis.

• Reagents
• VDRL antigen
• Positive control serum
• Negative control serum

10/21/2023 Alem E. 180

C. Widal test

• It is used for dx of typhoid and paratyphoid fever

caused by microorganism like S.typhi, s. parathphi A,
S. paratyphi B.

• Reagents
• S. typhi “O” antigen suspension
• S. typhi “ H” antigen suspension
• Polyspecific positive control
• Negative control
10/21/2023 Alem E. 181
D. Test for Rheumatoid factor(RF): rheumatoid factor is
autoantibody produced by the human body against self
antigen.

Reagents

• RF latex reagents modified fraction of Immunoglobulin

G(IgG)

• Positive control

• Negative control
10/21/2023 Alem E. 182
E. Serological diagnosis of viral hepatitis

• Hepatitis or inflammation of the liver is mainly caused by

hepatitis viruses such as hepatitis A virus(HAV), Hepatitis B
virus( HBV), hepatitis C virus(HCV), hepatitis Delta
virus(HDV).

• HBV is the commonest virus which causes viral hepatitis.

• Serological test using latex agglutination and

innumochromatography are the common rapid serological
tests used for dx of hepatitis B virus infection.
10/21/2023 Alem E. 183
I. Latex agglutination test for hepatitis B virus surface
antigen(HBsAG)

• Material and reagents required

• Latex agglutination test kit consisting of
• HBsAG latex reagents: latex particles coated with
antibodies against HBsAG
• Negative control
• Positive control
• Pipette- stirrers: single use specimen dropper/ stirrers
• Disposable agglutination
10/21/2023 Alemslide
E. 184
II. Immuno chromatographic test for hepatitis B surface
antigen

• Materials required
• Test device
• Disposable plastic dropper
• Test tube
• Test tube rack
• Centrifuge
• Anticoagulant
10/21/2023 Alem E. 185
F. Diagnosis of pregnancy

• Human chrionic gonadotropin(HCG) hormone is secreted by the

chrionic cells after fertillization of the ovum.

• The routine pregnancy test aims to detect HCG in urine.

A. Agglutination test

• pregnancy latex reagent; a suspension of antobody coated latex

particles in a buffer containing 0.1%sodium azide.

• Positive control

• Negative control
10/21/2023 Alem E. 186
B. Strip test

Reagents

• Pregnancy test strips

• Specimen collection material

10/21/2023 Alem E. 187

E. Rapid test for malaria parasite

• The development of RDT has open new

perspectives in the dx of malaria.

• These RDT are easy to perform, results can be

obtained with in short period of time and they do
not require extensive training.

10/21/2023 Alem E. 188

A. PreciMALARIA P.F/P.V - Reagents/material required

• Malaria P.f/P.v antobody coated dipsticks buffer viral and

droppers

• Lancet

B. Care start rapid test: it detects all species of malaria

Material/reagents required

• Test device

• Assay buffer
10/21/2023 Alem E. 189
 Clinical chemistry tests
• Clinical chemistry tests assess body’s chemical balance.

• Liver function test, renal function test, measurement of

glucose, uric acid, lipid and protein levels are typical
chemistry tests

• Reagents and standards in the form of kits are of high

quality but may be expensive.

10/21/2023 Alem E. 190

1. Renal function test

• The two important renal function tests are urea and

creatinine

A. Urea: is a main end product of protien metabolism in the

body.

• Urea is excreted by the kidney in urine . Therefore, its

measurment in serum and urine can be used to assess
kidney’s function

• There
10/21/2023are three methods forAlem
the
E. determination of blood191urea
i. Urease method using Nessler’s reaction

Reagents required

• Enzyme reagent(R1)

• Starter reagent(R2)

• Urea standard(40mg/dl)

• Distilled water

10/21/2023 Alem E. 192

ii. Urease method using berthelot reaction

Reagents required

• Buffer reagent(R1)

• Enzyme reagent(R2)

• Chromogen reagent(R3)

• Urea standard]distilled water

10/21/2023 Alem E. 193

iii. Diacetyl monoxime method

Reagent

• Stock acid reagent

• Mixed acid reagent( sulfuric acid and stock acid reagent

• Stock color reagent A (Diacetyl monoxime)

• Stock color reagent B

• Mixed color reagent ( stock color reagent A and B)

• Urea standard 40mg/dl

• 10/21/2023
Distilled water Alem E. 194
B. Creatinine:- measurement is used in the dx and
treatment of renal disease and monitoring patients on
renal dialysis.

Reagents

• Picric acid reagent(R1)

• Buffer reagent(R2)

• Creatinine standard 2mg/dl

• Distilled water
10/21/2023 Alem E. 195
2. Liver function tests

• LFTs are a group of clinical chemistry tests designed to

give information about the state of a patient’s liver

• Several biochemical tests are useful in the evaluation

and management of patients with hepatic dysfunction.

• LFTs include Bilirubin, SGOT, SCPT and ALP

10/21/2023 Alem E. 196

A. Bilirubin
• It is formed from hem fragment of aged or damaged red
blood cells.
• Jendrassik and Grof’s method is used to determine
bilirubin level in patients serum.
Reagents required
• Sulphanic acid reagent
• Soduim nitrite solution
• Diazo reagent
• Alkaline taratarate reagent
• Ascorbic acid solution
• Standard bilirubin solution
•10/21/2023
Distilled water Alem E. 197
B. Serum glutamate oxaloacetate transaminase(SGOT)
• SGOT is also known as aspartate aminotransferase(AST).
• It is an enzyme associated with liver parenchymal cells
and is raised in acute liver damage.
Reagents
• Phosphate buffer ( disodium hydrogen phosphate and
potassium dihydrogen phosphate)
• AST substrate(DL- aspartic acid and alpha- ketoglutrate
• Pyruvate standard
• Color reagent(2,4 dinitrophenylhydrazine)
• 0.4M sodium hydroxide

10/21/2023 Alem E. 198

C. Serum glutamate pyruvate transaminase(SGPT)
• Its also known as Alanine Amino Transferase (ALT)
• It is an enzyme present in hepatocytes(liver cells).
• Its concentration in the serum raises in liver damage.
Reagents
• Phosphate buffer(Disodium hydrogen phosphate and
potassium dihydrogen phosphate.
• ALT substrate(DL- alanine and alpha- ketoglutrate)
• Pyruvate standard
• Color reagent(2,4- dinitrophenylhydrazine)
• 0.4M sodium hydroxide
10/21/2023 Alem E. 199
D. Alkaline phosphatase(ALP)
• It is an enzyme in the cells of lining the biliary duct of
the liver.
• ALP levels in plasma rises with large bile duct
obstruction, intrahepatic cholestasis or infiltrate disease
of the liver.
Reagents
• Buffer(2-amino 2 methyl 1-propranol and 6M Hcl)
• Substarate( sodium parnitrophenyl phosphate)
• 0.25M sodium hydroxide
• Stock paranitrophenol 10.8 mmol/L
• Distilled water
10/21/2023 Alem E. 200
3. Blood glucose measurement

• Glucose is a reducing monosaccharide that serve as

a principal fuel for all tissues.

• Glucose measurement is important for dx of

diabetes.

• It can be measured photo metrically and by rapid

test using test strips.

10/21/2023 Alem E. 201

A. Photometric measurement- by glucose oxidase
enzymatic method
Reagents
• Phosphate buffer(disodium hydrogen phosphate di
hydrate and potassium di hydrogen phosphate.
• Color reagents
• Working glucose( stck glucose solution, benzoic acid)

B. Rapid blood glucose test

• The test can be performed by visual comparison with

standard or using glucometer

10/21/2023 Alem E. 202

4. Electrolytes

• The electrolytes found in the body are Major cations(Na, K,

Mg and Ca) and Major anions(Cl, Hco3, Po4 and SO4).

A. Sodium and Potassium measurement by flame photometry

• Sodium is the main extra cellular cations and it plays a role in

fluid distribution among body compartments.

• Potassium is the major intracellular action.

• It is widely distributed in muscle tissue, nerve tissue, blood

cells and plasma.
10/21/2023 Alem E. 203
Reagents required

• Stock sodium solution 100mmol/L

• Stock potassium 100mmol/L

• Working standards

10/21/2023 Alem E. 204

5. Urine analysis

• Testing of urine requires low technology. Test strip

technology is used in many laboratories.

• The test strips require good laboratory practice to

prevent premature expiration.

• The routine tests for urine analysis are grouped in three;

physical, chemical and microscopic examination.

10/21/2023 Alem E. 205

6. Parasitological tests

• The common parasitological tests are:

• Stool examination for intestinal parasites
• Examination of blood film for hemoparasites
• Examination of tissue aspirates for tissue parasites

10/21/2023 Alem E. 206

A. Stool examination for intestinal parasites: there are
two approaches of stool examination to diagnose
intestinal parasites

I. Direct method

Reagents

• Dobells iodine( iodine, potassium iodide)

• Physiological saline

10/21/2023 Alem E. 207

II. Concentration method: there are two concentration method

a. Zinc sulphate concentration method(flotation method)

Reagents

• Zinc sulfate

• Distilled water

b. formol- Ether sedimentation technique

• 10% formalin: formaldehyde and distilled water

• Diethyl ether
10/21/2023 Alem E. 208
B. Blood and tissue parasite: stained preparations are
microscopically examined for diagnosis of blood and
tissue parasites.

10/21/2023 Alem E. 209

 Microbiological tests

• Microbiological tests include microscopic examination

of stained preparation(gram and AFB stain), wet
mount(KOH), and isolation of a microorganism on
artificial media (culture sensitivity test).

10/21/2023 Alem E. 210

A. Gram stain
• Reagents/ materials required
• Crystal violet
• Ethanol 95%
• Ammonium oxalate
• Iodine
• Potassium iodide
• Acetone 99%
• Safranin O/neutral red
• Microscope slide
• Immersion oil

10/21/2023 Alem E. 211

 B. Wet preparation

Reagents/material required

• Sodium chloride

• Potassium hydroxide(KOH)

• Microscopy slide

10/21/2023 Alem E. 212

C. Sputum microscopy for acid fast bacilli(AFB) smears

Reagents/ material required

• Basic(carbol) fuchsin

• Methanol/ethanol absolute

• Methylene blue

• Phenol crytals

• HCL

• Immersion oil
10/21/2023 Alem E. 213
 Culture and sensitivity test

• Culture and sensitivity test is important to isolate

microorganism to the species level and determine
antibiotic sensitivity pattern.

• This test is frequently used to isolate bacteria and

fungi on artificial liquid(broth) or solid(agar) media.

• Most cultures require supplements for isolation of

microorganisms.

10/21/2023 Alem E. 214

• Isolation and identification of microorganisms also
require differentiation reagents, strips and disks.

• After isolation, antibiotic disks are used to

determine the sensitivity pattern of isolated
organism.

10/21/2023 Alem E. 215

 Thank you!!!

10/21/2023 Alem E. 216