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Faulty Analysis Method of A Patient Monitor | NIBP Fault Analysis and Troubleshooting

Faulty Analysis Method of A Patient Monitor | NIBP Fault Analysis and Troubleshooting
The monitor measures NIBP using the vibration wave method. During the measurement process, the pulsation of the blood vessel wall caused by the blood flow will generate a gas vibration wave in the cuff, and the vibration wave will be transmitted to the pressure sensor in the machine through the trachea to detect the cuff pressure in real-time. There are two common faults:
Fault 1: When performing NIBP measurement, it prompts "cuff error", "air pump leak" or pressure error alarm. It is generally caused by airway leakage, blockage, or failure of the blood pressure module pump and air release valve.
Checking steps:
(1) Check that the extension tube and cuff are not obviously damaged or folded and blocked, and need to be replaced if necessary.
(2) Check whether the extension tube is tightly connected with the cuff and the port of the machine. If necessary, clean the port with alcohol.
(3) The air pipe in the machine falls off or becomes loose, causing air leakage. At this time, the machine needs to be disassembled to reconnect and reinforce the internal pipe.
(4) Troubleshoot the air pump and air release valve on the NIBP module.
①Air pump detection: Remove the air pump and connect it to the 12V DC power supply to test whether the air pump works and the air output is normal. If it is not normal, the air pump is damaged and needs to be replaced;
②Bleed valve detection: Dust accumulation in the valve will cause the valve to be closed loosely or the airway in the valve to be blocked, which will cause the monitor to indicate air leakage fault or pressure error alarm respectively. At this time, the air valve can be removed, and the inside of the valve can be cleaned with a syringe. Replace the bleed valve or the NIBP module if necessary.
Fault 2: The external air circuit is intact, and it can be filled and deflated normally, but there is no blood pressure value or the blood pressure value is inaccurate.
Checking steps:
(1)Choose an appropriate size cuff, remove the body surface barrier and squeeze out the gas in the cuff before binding the cuff. If the cuff is too loose or too tight, the gas in the cuff will not be able to feel the pulsation of the blood vessel wall normally and generate vibration waves, resulting in inaccurate blood pressure measurement or inaccurate measurement.
(2) The influence of the patient's own activities is excluded. One of the main disadvantages of using the vibration wave method to measure NIBP is that it is easily disturbed by external vibration. Therefore, the NIBP measurement should be carried out in a calm state.
(3) The cuff binding position and patient posture should be correct. The results of the study show that for every 10cm difference between the position measured by NIBP and the height of the heart, the measured blood pressure value will differ by about 8mmHg. Therefore, when measuring NIBP, the measurement position should be kept at the same height as the heart.
(4) The failure of the blood pressure module should be considered. Damage to the pressure sensor or signal processing system in this module will result in no measurement results or inaccurate measurement values. In this case, the module needs to be disassembled for maintenance or replacement.

Faulty Analysis Method of A Patient Monitor | SpO2 Related Fault Analysis and Troubleshooting

Faulty Analysis Method of A Patient Monitor | SpO2 Related Fault Analysis and Troubleshooting
The measurement of SpO2 by the monitor uses the light absorption characteristics of Hb and HbO2-εcd in blood and based on Lambert Beer's law I=I0e (where I and I0 are the incident and transmitted light intensity respectively, ε, c, d are respectively material absorption coefficient, solution concentration, and light travel path). There are 2 common faults:
Fault 1:
In the normal, there is no blood oxygen waveform and digital display in the normal boot conditioning waveform and digital display, which is generally caused by the damage of the blood oxygen probe or the failure of the blood oxygen module.
Troubleshooting steps: Connect the blood oxygen probe correctly and start the test.
(1) Determine whether the blood oxygen probe is in good condition. You can check whether the diode in the probe is lit normally or replace it with a new probe directly to eliminate it. If the probe is determined to be damaged, it needs to be replaced. The damage to the PO2 probe is generally divided into two types:
①The light-emitting diode or photodiode in the finger sleeve is burnt;
②The inner wire of the connector is desoldered. At this time, you can unscrew the connector and re-solder the line.
(2) Check whether the machine probe connection port and its line are normal. Probe connection failure can be caused by the port to which the probe is connected, the connected line, or the connector falling off or loose. At this time, it is necessary to disassemble the machine to re-fix the ports and lines, and then connect the probe to test.
If the possible faults mentioned in the previous two steps have been eliminated, but the machine still has no blood oxygen waveform and digital display, the oxygen module fault should be considered and need to be repaired or replaced.
Fault 2:
The blood oxygen waveform and numbers are displayed, but the waveform interference is large or the blood oxygen measurement value is inaccurate. The blood oxygen waveform interferes greatly or the measured value is inaccurate, which is generally caused by external environmental factors.
Troubleshooting steps:
(1)Exclude the interference of the patient's own activities, and make the patient quiet before testing. Care should be taken to detect the effects of light in the environment. From the light absorption characteristics of HbO2 and Hb shown in Figure 1 and Lambert Beer's law (I=I0e), it can be seen that when there is strong light (especially red light and infrared light) in the detection environment, it may cause changes in I0 and I, resulting in inaccurate measurements.
(2)Note the effect of dyes. If the patient is injected with a dye before the SpO2 measurement, it will change the blood concentration (c) and the absorption coefficient (ε), affecting the final measurement result.
(3)Avoid taking measurements on the same side as NIBP or using the same finger for extended periods of time. The long-term compression of the same finger by the SpO2 probe finger cuff and the compression effect of the cuff on the arm during NIBP measurement may lead to poor blood circulation in the finger, which may easily cause measurement errors and patient discomfort.

Focus on Women: Trends in Breast Ultrasound |Predictions for the future of breast imaging with ultrasound

Focus on Women: Trends in Breast Ultrasound |Predictions for the future of breast imaging with ultrasound

The breast ultrasound market is seeing growth, driven largely by the proliferation of recent legislation aimed at addressing the unique challenges of imaging dense breast patients. Today, many governmental screening programs encourage the use of breast ultrasound for women with dense breast tissue, largely because ultrasound can differentiate between normal dense tissue and lesions better than traditional 2-D mammography. As the breast ultrasound market continues to grow, its impact on the breast care continuum naturally rises in tandem.

Amidst this market expansion, it becomes increasingly important to understand today’s breast ultrasound trends, as they hint at where the industry is headed in the future and predict what we can expect to see in the coming years.

The Rise of Shear Wave Elastography

Although ultrasound receives exceptional marks for sensitivity, its specificity has long been a shortcoming of the modality with notable opportunities for improvement. In response, shear wave elastography has been growing in popularity thanks to its ability to help increase clinicians’ diagnostic accuracy and subsequently impact specificity.

Although some professionals gave shear wave elastography a somewhat lackluster welcoming in the technology’s infancy due to uncertainty surrounding its usefulness, the latest generations of shear wave elastography have reversed this perception for many thanks to its notable benefits and improvements, including the clear diagnostic value the technology imparts. Today, the added value of shear wave elastography is recognized by major scientific societies in ultrasound, and it is backed by a long track record of scientific research with countless breast imaging publications. Shear wave elastography has been found to aid in the diagnostic workup of breast lesions, which positively impacts patient management.It also helps with targeting lesions during the ultrasound-guided biopsy,
and it contributes to an accurate lesion size measurement.

In addition, the technology plays a role in prognostics and monitoring of breast cancer patients during and after neoadjuvant chemotherapy.

Recently, 3-D shear wave elastography was introduced to the field, further enhancing the technology by providing the ability to visualize breast tissue in any plane of 3-D volume and allowing readers to preview information on the elasticity distribution inside and around the lesion.

Looking to the future, there will likely be more widespread adoption of the technology as ultrasound users increasingly recognize the added diagnostic value of evaluating tissue stiffness alongside b-mode and other traditional ultrasound imaging modes, particularly for the purposes of more confidently downgrading lesions to avoid unnecessary biopsies.

The Expanded Role of Automation and AI

There are countless opportunities to improve the efficiency and workflow of ultrasound exams, and there is a demand for solutions to address these challenges. In fact, in a recent survey, 90 percent of ultrasound users agreed that workflow efficiency is an important consideration when purchasing a new ultrasound system. Given this environment, it’s evident there will be an uptick in ultrasound innovations striving to optimize workflow and cut back on time-consuming inefficiencies of the ultrasound exam.

The reality is that a lot of the current ultrasound workflow could potentially be augmented — or even completely supplanted — by technology, particularly with future artificial intelligence (AI) integrations. This includes tasks such as documentation, annotation, and time spent looking for lesions on images, which could readily be addressed with AI-based tools that allow for pre-selection of relevant images, automatic or semi-automatic measurements, enhanced labeling, and reporting, and beyond.

Furthermore, variability in inter-reader breast lesion assessment with ultrasound, growing workloads, and limited staff continue to be significant challenges for the breast imaging community. AI and machine learning-based tools can empower physicians and sonographers to overcome these challenges. They are expected to help improve diagnostic accuracy by increasing both sensitivity and specificity, increase diagnostic confidence with decision-making support tools, increase reproducibility by addressing inter-reader variability and decreasing operator dependency, and improve the overall user experience.
There will clearly be a significant role for automation and AI to play in the future of ultrasound, and this is being fast-tracked by the COVID-19 pandemic. In the short term, the pandemic has accelerated the development of AI software across the healthcare sector overall and highlighted the need for further investment in AI-based medical imaging and machine learning tools for patient screening, triage, and monitoring. In addition, the pandemic has increased investment in technology for faster response time and more ubiquitous use of AI.

With the increased focus on overcoming barriers to entry, COVID-19 could become an accelerant to the long-lasting adoption of AI in the healthcare sector, and this will naturally parlay into the breast ultrasound industry, which is ripe with opportunities for AI to make a definitive impact on workflow efficiencies and outcomes.

The Reduction of Repetitive Stress Injuries

Finally, a lingering challenge associated with ultrasound imaging is the continued prevalence of repetitive stress injuries and musculoskeletal disorders associated with scanning. There is a clear need for targeted solutions, as research suggests approximately 80-90.5 percent of sonographers are scanning in pain.

Thankfully for sonographers, we are already seeing a rise in technology innovations pointed toward enhancing ergonomics through thoughtful design considerations. An example of this is a movement away from the traditional trackball used by many ultrasound systems toward a touch pad design that aims to reduce users’ movements and mimic the intuitive functionality of the ubiquitous smartphones permeating today’s society. Another example is design adjustments to the transducers themselves, which are becoming lighter and more ergonomic than in prior generations.

We expect ergonomic design considerations will continue to rise in prevalence in future ultrasound technology, particularly because ultrasound users have rallied behind the improvements. In one study, ultrasound users agreed that ergonomics is an important consideration when making a new ultrasound system purchasing decision.

Although one cannot know definitively what the future of breast ultrasound holds in the next 10+ years, the challenges and trends of today provide a road-map for where we are headed and what advancements may help us get there. What we do know with certainty is that ultrasound will remain an essential tool in a breast imager’s arsenal for managing breast health across the care continuum. Medical technology manufacturers working in close unison with clinicians, sonographers, and patients will be the most successful at driving these innovations and setting the tone for the future of breast ultrasound.