Siemens Healthcare Diagnostics

SUMMER INTERNSHIP REPORT

HEALTHCARE IMAGING AND DIAGNOSTIC

METHODS AND MACHINES

Supervised By: Mr. Sunil Kumar Garg

Under Guidance of: Mr. Girish Sadana

Submitted By: Viraj Agnihotri

1

HEALTHCARE IMAGING AND

DIAGNOSTIC METHODS AND

MACHINES

ACKNOWLEDGEMENT

I take this opportunity to express my profound sense of

gratitude and appreciation to all those who have helped me

throughout the duration of this internship.

Firstly, I would like to thank Mr. Sunil Kumar Garg and

Mr. Girish Sadana for providing guidance and expert

supervision during this internship and sharing their

experience in their field of work which helped me gain an

insight of the Healthcare industry in India.

I would also like to thank Mr. Saumay Kumar and Mr.

Tauseef Siddiqui for providing me with my study material

and helping me by clarifying my doubts whenever

required.

I would especially like to thank Mr. Madan Bharti from

Siemens Healthcare for providing moral support whenever

needed.

ABSTRACT

A well planned, properly executed industrial training helps a

lot in inducing good work culture. It provides a linkage

between the students and industry in order to develop

awareness of industrial approach to problem solving based

on broad understanding of processes and operations in an

industrial organization.

AIMS AND

OBJECTIVES

AIM: To see the application

of bioengineering in

healthcare industry

OBJECTIVES:

1. To understand various

diagnostic processes

2. To understand various

principle involved in

working of medical

equipment.

3. To learn about the

application of diagnostic

tools in medical research

4. To understand the

operating of Healthcare

Industry

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The report is based on the various products of SIEMENS which are dedicated towards

diagnosing and to analyze its utilization by generating different types of critical and

specific reports as per the needs of the management.

The system being diversified in nature demanded a 5 weeks period for understanding

the principles, concepts, operations of the various instruments and familiarizing with

the platform of their development for the completion of the project.

The training undertaken in such an indigenous company gave me an opportunity to

gain practical experience increasing my horizon of knowledge. I have tried to share

some of my knowledge by way of this project report.

ABOUT THE COMPANY

Siemens Worldwide:

Werner Von Siemens in Berlin, Germany incepted Siemens on 1st October 1647.

Initially there were three units in different areas of operation: SRW-Siemens Reiniger

werke (Medical Engineering), SSW-Siemens Schukert Werke (energy) and SH_Siemens

Halske (Communication). They finally merged into Siemens AG (Aktiengesellschaft) in

the 1970’s.

Ever since its evolution Siemens had been at the forefront of developing leading

edge .It has a strong global presence having sales and service facilities in more than 190

countries and with 339 production facilities outside Germany with worldwide

manpower strength of about four lakhs.

To continue with its pioneering research and to stay ahead in the field of

electrical and electronic technology, Siemens put strong emphasis on research and

development with over 4500 employees engaged in this key activity of approximately

8% of the turnover. On an average Siemens spends DM 35 million a day on R&D and

has its R&D centres in Europe and USA apart from Germany.

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Siemens in India:

Siemens ltd is a leading electrical and electronics engineering company in India.

Established in 1922, it was incorporated as a company in 1957 and in 1962 was

converted into a public limited company with 51 % of its equity held by Siemens AG

and the remaining 49 % held by Indian shareholders. It operates in the energy,

industry, healthcare, transportation, information, communications and components

business segments. It also operates joint ventures in the fields of communication and

information technology.

In addition Siemens group in India has presence in the field of power design,

renovation and modernization of existing power plant, lighting, and household goods.

The Siemens group in India has a widespread marketing and distribution

network in addition to multiple manufacturing processes in India. It also has a well-

organized up-market value addition in engineering, software, system integration,

erection, and commissioning and customer services.

Siemens long association with India begins in the year 1867 when Werner Von

Siemens personally supervised the laying of the first transcontinental telegraphic line

between Calcutta and London.

Siemens has played an active role in the technological progress experienced in the

last three decades. In the 60’s the nations expanding investments in power generation

called for a range of high quality electrical and auxiliary equipment. Siemens grew out

of response to this need.

First in a small way assembling switchboards at workshop in Bombay and

Calcutta. With products as varied as Switchgears, Motors, Drives and Automation,

Power systems automation, Railway signaling systems, Medical engineering and

telecommunication equipment.

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Siemens extensive network in India includes 10 manufacturing units, 12 sales

offices, 30 representatives, 350 dealers, and system houses. Being closely related to

Siemens AG, Germany gives Siemens India access to the world’s latest developments in

every field. Siemens technology has been made available to the reputed Indian

organizations in the form of collaboration agreements with BHEL, BEL, HMT, ECIL

and Mafatlal industries to name a few.

SIEMENS HEALTHCARE

Medical engineering is constantly enhancing the

effectiveness of the diagnostic and therapeutic

modalities now available to the medical

profession. The rapid advances in electronics

have resulted in phenomenal benefits accruing

to modern medicine. Non-invasive, imaging,

faster and accurate diagnosis and paper free

documentation of patient data are just a few of

the benefits.

Biomedical

Imaging

Laboratory Diagnostics

Healthcare

Diagnostics

“At Siemens, we play a unique role, supporting healthcare professionals to do their job the best they can by providing medical technologies that help deliver a better quality of healthcare and enable ever-improving degrees of individual care through

advanced imaging, diagnostics, therapy, and healthcare IT solutions. We thereby help ensure the next generation of breakthroughs becomes a reality.”

- Hermann Requardt, Member of the Managing Board of Siemens AG and CEO of the Healthcare Sector

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BIOMEDICAL IMAGING

• Microscopy

• Ultrasound

• X-rays

• CT

• SPECT & Gamma Camera

• NMR & fMRI

• PET

MICROSCOPY

• main branches: optical, electron and scanning probe microscopy. (+ less used X-ray

microscopy)

• Optical and electron microscopy involves the diffraction, reflection, or refraction of radiation

incident upon the subject of study, and the subsequent collection of this scattered radiation in

order to build up an image.

• Scanning probe microscopy involves the interaction of a scanning probe with the surface or

object of interest.

OPTICAL MICROSCOPY:

• Optical or light microscopy involves passing visible light transmitted

through or reflected from the sample through a single or multiple lenses to

allow a magnified view of the sample.

• The resulting image can be detected directly by the eye, imaged on a

photographic plate or captured digitally.

• OM can only image dark or strongly refracting objects effectively. Out of

focus light from points outside the focal plane reduces image clarity.

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ELECTRON MICROSCOPY

• developed in the 1930s that use electron beams instead of light.

• because of the much lower wavelength of the electron beam than of light, resolution is far

higher.

TYPES

• Transmission electron microscopy (TEM) is principally quite similar to the compound light

microscope, by sending an electron beam through a very thin slice of the specimen. The

resolution limit (in 2005) is around 0.05 nanometer.

House Fly Black Ant

Human RBCs Neurons CNS

• Scanning electron microscopy (SEM) visualizes details on the surfaces of cells and

particles and gives a very nice 3D view. The magnification is in the lower range than that of the

transmission electron microscope.

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ULTRASOUND

• It is used to visualize muscles, tendons, and many internal organs, their size, structure and

any pathological lesions with real time tomographic images. They are also used to visualize a

fetus during routine and emergency prenatal care.

• The technology is relatively inexpensive and portable, especially when compared with

modalities such as magnetic resonance imaging (MRI) and computed tomography (CT).

• It poses no known risks to the patient; it is generally

described as a "safe test" because it does not use

ionizing radiation, which imposes hazards (e.g.

cancer production and chromosome breakage).

• However, it has two potential physiological effects:

it enhances inflammatory response; and it can heat

soft tissue.

• It uses the same principles involved in the sonar

used by bats, ships and fishermen.

• When a sound wave (frequency 2.0 to 10.0

megahertz ) strikes an object, it bounces backward

or echoes. By measuring these echo waves it is

possible to determine how far away the object is and

its size, shape, consistency (solid, filled with fluid, or

both) and uniformity.

• A transducer both sends the sound waves and

records the echoing waves. When the transducer is

pressed against the skin, it directs a stream of

inaudible, high-frequency sound waves into the body.

As the sound waves bounce off of internal organs,

fluids and tissues, the sensitive microphone in the

transducer records tiny changes in the sound's

pitch and direction. These signature waves are

instantly measured and displayed by a computer,

which in turn creates a real-time picture on the

monitor.

• Ultrasound waves are reflected by air or gas;

therefore ultrasound is not an ideal imaging

technique for the bowel.

• Ultrasound waves do not pass through air;

therefore an evaluation of the stomach, small

intestine and large intestine may be limited.

The ACUSON X300™ ultrasound

system, premium edition (PE) is a

compact, portable imaging solution

that delivers exceptional clinical

performance across a wide variety

of applications. This

comprehensive, fully featured

system incorporates high-end

image optimization techniques and

enhanced workflow features to

meet the challenges of the most

demanding care environments.

Intestinal gas may also prevent visualization of deeper structures such as the pancreas and

aorta.

• Patients who are obese are more difficult to image because tissue attenuates (weakens) the

sound waves as they pass deeper into the body.

• Ultrasound has difficulty penetrating bone and therefore can only see the outer surface of

bony structures and not what lies within.

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ULTRASOUND - BIOMEDICAL APPLICATIONS

• heart and blood vessels, incl. the abdominal aorta and its major branches

• liver

• gallbladder

• spleen

• pancreas

• kidneys

• bladder

• uterus, ovaries, and unborn child (fetus) in pregnant patients

• eyes

• thyroid and parathyroid glands

• scrotum (testicles)

9

X-RAYS AND X-RAY BASED PRODUCTS

PROJECTION RADIOGRAPHY

The creation of images by exposing an object to X-rays or

other high-energy forms of electromagnetic radiation and

capturing the resulting remnant beam (or "shadow") as a

latent image is known as "projection radiography." The

"shadow" may be converted to light using a fluorescent

screen, which is then captured on photographic film, it may be

captured by a phosphor screen to be "read" later by a laser

(CR), or it may directly activate a matrix of solid-

state detectors (DR—similar to a very large version of

a CCD in a digital camera). Bone and some organs (such

as lungs) especially lend themselves to projection

radiography. It is a relatively low-cost investigation with a

high diagnostic yield.

Projection radiography uses X-rays in different amounts and

strengths depending on what body part is being imaged:

Hard tissues such as bone require a relatively high energy

photon source, and typically a tungsten anode is used

with a high voltage (50-150 kVp) on a 3-phase or high-

frequency machine to generate braking radiation. Bony

tissue and metals are denser than the surrounding tissue,

and thus by absorbing more of the X-ray photons they

prevent the film from getting exposed as much. Wherever

dense tissue absorbs or stops the X-rays, the resulting X-

ray film is unexposed, and appears translucent blue,

whereas the black parts of the film represent lower-

density tissues such as fat, skin, and internal organs,

which could not stop the X-rays. This is usually used to

see bony fractures, foreign objects (such as ingested

coins), and used for finding bony pathology such

as osteoarthritis, infection (osteomyelitis), cancer

(osteosarcoma), as well as growth studies (leg

length, achondroplasia, scoliosis, etc.).

Soft tissues are seen with the same machine as for hard

tissues, but a "softer" or less-penetrating X-ray beam is

used. Tissues commonly imaged include the lungs and

heart shadow in a chest X-ray, the air pattern of the bowel

in abdominal X-rays, the soft tissues of the neck, the

orbits by a skull X-ray before an MRI to check for

radiopaque foreign bodies (especially metal), and of

course the soft tissue shadows in X-rays of bony injuries

are looked at by the radiologist for signs of hidden trauma

(for example, the famous "fat pad" sign on a fractured

Multix Fusion is designed for

routine radiography and can be

tailored to your requirements, today

and in the future. Analog or digital,

with an upgrade path to digitize

whenever you decide.

In short, it's an investment that

fits.

MULTIMOBIL provides thoughtful

design and high quality. They are

designed as entry-level systems

with basic system features for all

mobile X-ray applications.

If you ask for the economical

solution without compromises our

MULTIMOBIL is the number one

choice for mobile X-ray imaging in

the ICU, neonatal or pediatric

departments, or in the ward.

10

elbow).

Dental radiography uses a small radiation dose with high

penetration to view teeth, which are relatively dense.

A dentist may examine a painful tooth and gum using X-

ray equipment. The machines used are typically single-

phase pulsating DC, the oldest and simplest sort. Dental

technicians or the dentist may run these machines—

radiologic technologists are not required by law to be

present.

Mammography is an X-ray examination of breasts and

other soft tissues. This has been used mostly on women

to screen for breast cancer, but is also used to view male

breasts, and used in conjunction with a radiologist or a

surgeon to localize suspicious tissues before a biopsy or

a lumpectomy. Breast implants designed to enlarge the

breasts reduce the viewing ability of mammography, and

require more time for imaging as more views need to be

taken. This is because the material used in the implant is

very dense compared to breast tissue, and looks white

(clear) on the film. The radiation used for mammography

tends to be softer (has a lower photon energy) than that

used for the harder tissues. Often a tube with

a molybdenum anode is used with about 30 000 volts (30

kV), giving a range of X-ray energies of about 15-30 keV.

Many of these photons are "characteristic radiation" of a

specific energy determined by the atomic structure of the

target material (Mo-K radiation).

FLUOROSCOPY

Fluoroscopy is a term invented by Thomas Edison during his

early X-ray studies. The name refers to the fluorescence he

saw while looking at a glowing plate bombarded with X-rays.

This is a technique that provides moving projection

radiographs of lower quality. Fluoroscopy is mainly performed

to view movement (of tissue or a contrast agent), or to guide a

medical intervention, such as angioplasty, pacemaker

insertion, or joint repair/replacement. The latter are often

carried out in the operating theatre, using a portable

fluoroscopy machine called a C-arm. It can move around the

surgery table and make digital images for the surgeon.

Angiography is the use of fluoroscopy to view the

cardiovascular system. An iodine-based contrast is injected

into the bloodstream and watched as it travels around. Since

liquid blood and the vessels are not very dense, a contrast

with high density (like the large iodine atoms) is used to view

MAMMOMAT 1000 is our mid-tier

analog screening mammography

system for high patient volumes.

The system provides excellent

image quality combined with a

range of features that inspire

comfort and confidence. A

radiation shield with control panel

allows you to operate the system

from a protected area.

Luminos Select is our fluoroscopy

system that provides economical

access to select technologies from

our proven Luminos fluoroscopy

systems. It offers imaging with up

to 90% less dose, the efficiency of

a fully digital workflow, and proven

reliability. The result is improved

productivity and diagnostic quality

with an investment you can make

with confidence.

11

the vessels under X-ray. Angiography is used to

find aneurysms, leaks, blockages (thromboses), new vessel

growth, and placement of catheters and stents. Balloon

angioplasty is often done with angiography.

Fluoroscopy can be used to examine the digestive system

using a substance which is opaque to X-rays, (usually

barium sulfate or gastrografin), which is introduced into the

digestive system either by swallowing or as

an enema. This is normally as part of a double contrast

technique, using positive and negative contrast. Barium

sulfate coats the walls of the digestive tract (positive contrast),

which allows the shape of the digestive tract to be outlined as

white or clear on an X-ray. Air may then be introduced

(negative contrast), which looks black on the film. The barium

meal is an example of a contrast agent swallowed to examine

the upper digestive tract. Note that while

soluble barium compounds are very toxic, the

insoluble barium sulfate is non-toxic because its low solubility

prevents the body from absorbing it.

A number of substances have been used as positive

contrast

agents: silver, bismuth, caesium, thorium, tin, zirconium, t

antalum, tungsten and lanthanide compounds have been

used as contrast agents. The use of thoria (thorium

dioxide) as an agent was rapidly stopped as thorium

causes liver cancer.

Most modern injected radiographic positive contrast media

are iodine-based. Patients who suffer

from allergy to shellfish may be allergic to iodine, and should

consult their physician regarding pre-medication to lessen risk

of allergic reaction. Iodinated contrast comes in two forms:

ionic and non-ionic compounds. Non-ionic contrast is

significantly more expensive than ionic (approximately three

to five times the cost), however, non-ionic contrast tends to be

safer for the patient, causing fewer allergic reactions and

uncomfortable side effects such as hot sensations or flushing.

Most imaging centres now use non-ionic contrast exclusively,

finding that the benefits to patients outweigh the expense.

The mobile C-arm MULTIMOBIL

5C provides the optimum

solution of today's clinical

requirements. It is ideally suited

for entry level surgery in many

application fields such as

orthopedics, trauma surgery,

general surgery.

Negative radiographic contrast agents are air and carbon

dioxide (CO2). The latter is easily absorbed by the body

and causes less spasm. It can also be injected into the

blood, where air absolutely cannot.

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COMPUTED TOMOGRAPHY SCAN (CT)

• CT scans use a series of X-ray beams

• It creates cross-sectional images, e.g. of the brain and

shows the structure of the brain, but not its function.

• Digital geometry processing is used to generate a three-

dimensional image of the internals of an object from a

large series of two-dimensional X-ray images taken

around a single axis of rotation

• CT's primary benefit is the ability to separate anatomical

structures at different depths within the body.

• A form of tomography can be performed by moving the

X-ray source and detector during an exposure.

• Anatomy at the target level remains sharp, while

structures at different levels are blurred.

• By varying the extent and path of motion, a variety of

effects can be obtained, with variable depth of field and

different degrees of blurring of 'out of plane'

structures.

• Because contemporary CT scanners offer isotropic, or

near isotropic, resolution, display of images does not

need to be restricted to the conventional axial

images.

SOMATOM® Definition is the

latest revolution in CT. Its new

Dual Source CT technology

promotes pioneering new

clinical opportunities at the

highest level, making it the

ideal choice for bigger hospitals

and research facilities.

• Instead, it is possible for a software program to build a volume by 'stacking' the individual

slices one on top of the other. The program may then display the volume in an alternative

manner.

1. 2. 3. 4.

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CT - DIAGNOSTIC USE

Cranial

• diagnosis of cerebrovascular accidents and intracranial hemorrhage

• CT generally does not exclude infarct in the acute stage of a stroke. For detection of tumors, CT

scanning with IV contrast is occasionally used but is less sensitive than magnetic resonance

imaging (MRI).

Chest

• CT is excellent for detecting both acute and chronic changes in the lung parenchyma.

• A variety of different techniques are used depending on the suspected abnormality.

• For evaluation of chronic interstitial processes (emphysema, fibrosis, and so forth), thin sections

with high spatial frequency reconstructions are used - often scans are performed both in

inspiration and expiration. This special technique is called High resolution CT (HRCT).

• For detection of airspace disease (such as pneumonia) or cancer, relatively thick sections and

general Purpose image reconstruction techniques may be adequate.

Cardiac

• With the advent of subsecond rotation combined with multi-slice CT (up to 64-slice), high

resolution and high speed can be obtained at the same time, allowing excellent imaging of the

coronary arteries (cardiac CT angiography).

• Images with an even higher temporal resolution can be formed using retrospective ECG gating.

In this technique, each portion of the heart is imaged more than once while an ECG trace is

recorded. The ECG is then used to correlate the CT data with their corresponding phases of

cardiac contraction. Once this correlation is complete, all data that were recorded while the

heart was in motion (systole) can be ignored and images can be made from the remaining data

that happened to be acquired while the heart was at rest (diastole). In this way, individual

frames in a cardiac CT investigation have a better temporal resolution than the shortest tube

rotation time.

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.

• Renal/urinary stones, appendicitis, pancreatitis, diverticulitis, abdominal aortic aneurysm, and

bowel obstruction are conditions that are readily diagnosed and assessed with CT.

• CT is also the first line for detecting solid organ injury after trauma.

14

SINGLE POSITRON EMISSION COMPUTED TOMOGRAPHY(SPECT)

• gamma ray emissions are the source of information

(contrary to X-ray transmissions used in conventional CT)

• allows to visualize functional information about a

patient's specific organ or body system (similarly to X-ray

Computed Tomography (CT) or Magnetic Resonance

Imaging (MRI)

• Internal radiation is administered by means of a

pharmaceutical which is labeled with a radioactive

isotope / tracer / radiopharmaceutical, is either

injected, ingested, or inhaled.

• The radioactive isotope decays, resulting in the emission

of gamma rays. These gamma rays give us a picture of

what's happening inside the patient's body.

• The Gamma camera collects gamma rays that are

emitted from within the patient, enabling us to

reconstruct a picture of where the gamma rays originated.

From this, we can determine how a particular organ or

system is functioning.

• The gamma camera can be used in planar imaging to

acquire 2-dimensional images, or in SPECT imaging to

acquire 3-dimensional images.

• Once a radiopharmaceutical has been administered, it is

necessary to detect the gamma ray emissions in order to

attain the functional information.

• The instrument used in Nuclear Medicine for the detection

of gamma rays is known as the Gamma camera. The

components making up the gamma camera are the

collimator, detector crystal, photomultiplier tube array,

position logic circuits, and the data analysis

computer.

• Since the camera remains at a fixed position in a planar

study, it is possible to observe the motion of a

radiotracer through the body by acquiring a series of

planar images of the patient over time.

The Inveon SPECT module is

part of the Inveon multimodal

platform and is available as a

SPECT•CT or a

PET•SPECT•CT system. With

large pixelated detector heads

mounted on a rotating stage,

the Inveon SPECT system

offers automated zoom

technology, multiple

application-specific collimator

options and upgradeability

features – making it a very

versatile system for all

SPECT imaging applications.

• Each image is a result of summing data over a short time interval, typically 1-10 seconds.

15

• If one rotates the camera around the patient, the camera will acquire views of the tracer

distribution at a variety of angles.

• After all these angles have been observed, it is possible to reconstruct a three dimensional

view of the radiotracer distribution within the body.

SPECT – APPLICATIONS

• Heart Imaging

• Brain Imaging

• Kidney/Renal Imaging

• Bone Scans

Brain Bones

Heart Kidney/Renal

16

MAGNETIC RESONANCE IMAGING (MRI)

• An MRI uses powerful magnets to excite hydrogen nuclei in water molecules in human tissue,

producing a detectable signal. Like a CT scan, an MRI traditionally creates a 2D image of a thin

"slice" of the body.

• The difference between a CT image and an MRI image is in the details. X-rays must be

blocked by some form of dense tissue to create an image, therefore the image quality when

looking at soft tissues will be poor.

• An MRI can ONLY "see" hydrogen based objects, so

bone, which is calcium based, will be a void in the

image, and will not affect soft tissue views. This makes

it excellent for peering into joints.

• As an MRI does not use ionizing radiation, it is the

preferred imaging method for children and pregnant

women.

• Magnetic resonance imaging (MRI), formerly referred

to as magnetic resonance tomography (MRT) and, in

scientific circles and as originally marketed by

companies such as General Electric, nuclear magnetic

resonance imaging (NMRI) or NMR zeugmatography

imaging, is a non-invasive method using nuclear

magnetic resonance to render images of the inside of

an object.

• It is primarily used in medical imaging to demonstrate

pathological or other physiological alterations of living

tissues.

• MRI also has uses outside of the medical field, such as

detecting rock permeability to hydrocarbons and as a

non-destructive testing method to characterize the

quality of products such as produce and timber.

MAGNETOM Trio, A Tim System

offers you a unique 3T platform

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MAGNETOM Trio, A Tim System

is the choice of the world’s

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research community.

• The scanners used in medicine have a typical magnetic

field strength of 0.2 to 3 Teslas. Construction costs

approximately US$ 1 million per Tesla and

maintenance an additional several hundred thousand dollars per year.

• Medical Imaging MRI, or "NMR" as it was originally known, has only been in use since the

1980's. Effects from long term, or repeated exposure, to the intense magnetic field is not

well documented.

• Functional MRI detects changes in blood flow to particular areas of the brain. It provides both

an anatomical and a functional view of the brain.

17

• MRI uses the detection of radio frequency signals

produced by displaced radio waves in a magnetic field.

It provides an anatomical view of the brain.

Functional MRI

• A fMRI scan showing regions of activation in orange,

including the primary visual cortex (V1, BA17).

• Functional MRI (fMRI) measures signal changes in the

brain that are due to changing neural activity. The brain

is scanned at low resolution but at a rapid rate (typically

once every 2-3 seconds). Increases in neural activity

cause changes in the MR signal via T2* changes; this

mechanism is referred to as the BOLD (blood-oxygen-

level dependent) effect. Increased neural activity

causes an increased demand for oxygen, and the

vascular system actually overcompensates for this,

increasing the amount of oxygenated hemoglobin

(haemoglobin) relative to deoxygenated hemoglobin.

APPLICATIONS • Clinical practice, MRI is used to distinguish pathologic

tissue (such as a brain tumor) from normal tissue. One

advantage of an MRI scan is that it is thought to be

harmless to the patient. It uses strong magnetic fields

and non-ionizing radiation in the radio frequency range.

Compare this to CT scans and traditional X-rays which

involve doses of ionizing radiation and may increase the

risk of malignancy, especially in a fetus

Biograph mMR brings a

revolution in diagnostic imaging

to life. For the first time, state-of-

the-art 3T MRI and cutting-edge

molecular imaging are fully

integrated as one. Only Siemens

makes the simultaneous

acquisition of whole-body MR

and PET possible.

Molecular MR supports our joint

vision for healthcare - to advance

disease management and

improve care for all patients.

Biograph mMR represents a bold

move forward in making this

vision a reality.

• While CT provides good spatial resolution (the ability to distinguish two structures an arbitrarily

small distance from each other as separate), MRI provides comparable resolution with far better

contrast resolution (the ability to distinguish the differences between two arbitrarily similar but

not identical tissues). The basis of this ability is the complex library of pulse sequences that the

modern medical MRI scanner includes, each of which is optimized to provide image contrast

based on the chemical sensitivity of MRI.

• The typical MRI examination consists of 5-20 sequences, each of which are chosen to provide a

particular type of information about the subject tissues. This information is then synthesized by

the interpreting physician

1

8

POSITRON EMISSION TOMOGRAPHY

(PET)

• A scanner detects radioactive material that is injected or

inhaled to produce an image of the brain.

• Commonly used radioactively-labeled material includes

oxygen, fluorine, carbon and nitrogen.

• When this material gets into the bloodstream, it goes to

areas of the brain that use it. So, oxygen and glucose

accumulate in brain areas that are metabolically active.

• When the radioactive material breaks down, it gives off a

neutron and a positron.

• When a positron hits an electron, both are destroyed and

two gamma rays are released.

• Gamma ray detectors record the brain area where the

gamma rays are emitted. This method provides a

functional view of the brain.

Advantages:

• Provides an image of brain activity. Disadvantages:

• Expensive to use.

• Radioactive material used.

Siemens Biograph™

TruePoint is a flexible, high-

powered medical imaging

platform. It offers an wide

range of performance options

to enhance image resolution

and quality, improve patient

satisfaction as well as

throughput. Customize the

Biograph solution to meet

your specific needs by

selecting from

various resolution and clinical

configuration options.

19

DIAGNOSTIC MEDICAL IMAGING

MRI fMRI

SPECT CT

X-RAY Ultrasound

rt

tion

20

LABORATORY DIAGNOSTICS

INTRODUCTION

WHAT CAN BE TESTED?

Body is made up of many different types of cells and fluids.

Almost all of these cells and fluids may be tested, though the most common specimens are

blood and urine.

Materials such as sweat, spinal fluid, joint fluid, sputum, hair, feces, bone marrow, tissues and

body scrapings are also analyzed.

Sample

Test

Order

Sample

Transport

Report

Distribution

Sample Processing

Repo

Genera

Analysis

Data

Review

SPECIMEN PROCESSING • Pre Centrifugation

• Centrifugation

• Post Centrifugation

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SECTORS FOR TESTING

• Hematology – Study of Blood cells

• Biochemistry –Study of Biochemicals in the body

• Immunology –Study of Antibodies and Antigen

• Microbiology –Study of Microorganisms

• Immunohematology – Deals with Blood Grouping

• Cytology & Histopathology– Study of cells and tissues of the body

• Molecular Biology –Study of Molecules like DNA and RNA

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HEMATOLOGY

TYPES OF TESTS

• RBC - the number of red blood cells to

evaluate anemia

• WBC - the number of white blood cells to

evaluate infection

• Differential Count - the proportions of the

different types of white blood cells varies in

infection, allergies, etc.

• Platelet Count - the count of the number of

these cells which participate in blood

clotting

• Coagulation (clotting) studies - bleeding

time, prothrombin time and other tests

determine the clotting process in the blood

• Hemoglobin - a measure of the oxygen-

carrying capacity of the blood

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BIOCHEMISTRY

TYPES OF TESTS

• Blood Sugar - Sugar in the blood is a

measurement for diabetes mellitus

• Electrolytes (Na, K, Cl & CO2) - substances

maintain fluid and blood pressure balance

(essential for the function of most body

systems)

• Enzymes (CK, LD, AST, ALT) - help to

diagnose heart and liver diseases

• Cholesterol - high amounts are associated

with heart and blood vessel diseases

• Urea Nitrogen - test for kidney function

• Uric Acid - may indicate gout

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2

4

MICROBIOLOGY

TYPES OF TESTS

• Culture - growth of bacteria for the

purpose of identification

• Smear/Stain - preliminary evaluation of

infection

• Sensitivity test - testing bacteria with

antibiotics to determine which drug is

most effective

IMMUNOLOGY

TYPES OF TESTS

• AIDS test - positive when a person has

the AIDS virus

• Pregnancy test - to confirm pregnancy

• Rubella test - for measles

IMMUNOHEMATOLOGY

TYPES OF TESTS

Blood type and Rh - to identify a person's blood

type which can be O, A, B or AB and Rh which

can be either positive or negative

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supplemental system for difficult organisms or

as a primary instrument for low volume usage.

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CYTOLOGY

TYPES OF TESTS

• Pap smear - microscopic examination of cells to determine abnormal conditions or malignancy

• Sputum - microscopic evaluation for malignancy or other disorders such as asbestosis

HISTOLOGY

TYPES OF TESTS Biopsy - the removal of a small section of tissue to be studied. The type of cells and their chemical

reactions are evaluated.

MOLECULAR BIOLOGY

TYPES OF TESTS

• Detection of major infectious diseases

• Monitoring of treatment efficiancy

• Diagnosis and monitoring of HIV and

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26

DIAGNOSTIC TOOLS HELPING IN

RESEARCH

THE DEVELOPMENT OF LANGUAGE, IN LIVING COLOR

AT THE BASQUE CENTRE ON COGNITION, BRAIN AND

LANGUAGE IN SAN SEBASTIAN, SPAIN, RESEARCH

SCIENTISTS ARE USING HIGH-END MEDICAL IMAGING

DEVICES FROM SIEMENS THAT GATHER DATA ON THE

INNER WORKINGS OF THE BRAIN TO EXPLORE THE HUMAN

MECHANISMS RELATED TO THE LEARNING, UNDERSTANDING

AND PRODUCTION OF LANGUAGE. -BY PETER SERGIO ALLEGRETTI

Wernicke’s area

Auditory cortex

Broca’s area

Motor cortex

This graphic highlights the areas of the brain used when speaking in your native language. But what would the graphic look like when learning a new language?

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Things that seem the simplest can often be the most complex.

Take for example the basic transmission of information. As you

read this article, you are most likely able to understand each of

the individual words as well as the meaning that the collection

of words together are intended to convey. Yet as you do that,

what is happening now in your brain and your body is an

extraordinarily complex and precisely choreographed series of

neurological and physical events. Now, imagine you were

reading this in another language – perhaps a second language

you had spoken since birth or one you acquired later. Would

you understand it in the same way? More specifically, would

your brain process the words and turn them into

“understanding” in the same way?

Finding answers to these questions is a key focus of the work

being carried out at the Basque Centre on Cognition, Brain and

Language (BCBL) in Spain. The Centre is situated in San

Sebastian, an elegant coastal city and an ideal place to study

the bilingual brain. San Sebastian is located at the heart of the

Basque Country where inhabitants speak both Spanish and

Basque, two languages that are completely unrelated, yet are

used side by side in daily life.

The BCBL’s key aim is to unravel the mysteries and explore

the mechanisms in the brain related to the learning,

understanding, and production of language. In essence,

scientists are working to understand what happens on a neuro-

cognitive level when we speak, listen, and learn, and to

understand how the brain takes on a second or third language.

The centre gets its answers with the help of advanced medical

devices that gather data on the inner workings of the brain. The

BCBL employs a wide array of technology, including high-end

functional magnetic resonance imaging (fMRI) equipment from

Siemens as well as electroencephalogram (EEG) and

magnetoencephalogram (MEG) equipment.

“It’s all about posing the right questions.” Manuel Carreiras, Scientific Director, Basque Centre on Cognition, Brain and Language, San Sebastian, Spain

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“As I watch one volunteer slide into the Siemens MAGNETOM® Trio™, a Tim (total imaging matrix) system, 3 Tesla fMRI unit, I am taken around to see how video information is fed onto a small screen above the volunteer and how audio is piped into the headphones. As a language test gets underway, I watch the results being recorded and displayed on a bank of computer screens. It is extraordinary to see images of such clarity and to watch different parts of the brain “light up” as challenges are posed to the volunteers. In this case, the woman in the MR system is given a series of words that are totally or partially contradictory together with some that are not. Researchers want to know more about which parts of the brain are activated when things make sense and which parts are activated when it is confused. The enormous benefit of actually being able to see this neuro-cognitive activity means researchers can make what they call “neuro-correlates” or matches between brain activity and behavioural activity. The benefit of using the MAGNETOM system is that it is excellent at producing 3D spatial results – images that can be seen and interpreted visually. “The MAGNETOM with 3 Tesla has great spatial resolution,” says BCBL Research Scientist Pedro Paz Alonso. “Compared to other neuroscientific imaging techniques, with this system we get to look not only into the gray matter in the brain surface, but also to white matter anatomical pathways inside the brain. Naturally, this gives us quite useful information. We also use EEG and MEG equipment that offers better temporal resolution.” Coupled together, researchers have an extraordinary amount of data available to them. The process of putting it all together can take months.”

- Peter Sergio Allegretti

“With Siemens’ 3 Tesla system, we get to look deep inside the brain instead of just at the surface.” Pedro Paz Alonso, Research Scientist, Basque Centre on Cognition, Brain and Language, San Sebastian, Spain

BCBL uses a MAGNETOM Trio on a study participant to measure her neuro-cognitive activity.

29

fMRI Technology: A New Way of Looking at Language

Siemens fMRI technology makes it possible for researchers to get extraordinary pictures of brain

activity with excellent 3D spatial resolution. Identifying language and speech disorders is now more

advanced thanks to fMRI, which means treatment plans are more efficient and suitable to patients.

But fMRI is also being used in life-saving clinical applications. One of the most common uses is to carry

out pre-surgical mapping of a brain with a tumor. Before an operation and within a matter of minutes, an

fMRI scan can give doctors critical data and clear pictures about the location of the tumor and pinpoint

functional areas of the brain with great accuracy, so that the surgeon can precisely remove all

malignant tumoral tissue without damaging critical functional areas, such as those responsible for

speech. This gives the surgeon crucial information about how best to operate. With a magnetic field of

3 Tesla, MAGNETOM® Trio™, a Tim system, has twice the power of the standard scanner, which

means greater speed, accuracy, and image clarity in fMRI studies. What is extraordinary about fMRI technology is that researchers can peer deep into the in vivo brain

while it is functioning, without any invasiveness. That is what makes this “currently the most exciting

technology for the functional mapping of the brain,” according to Siemens MR Neurology Global

Segment Manager Ignacio Vallines. “The benefits for patients, surgeons, and researchers alike are

enormous.”

Vallines also highlights the important work being done with stroke sufferers. The ability to see the

locally affected areas of the damaged brain and to track the hemispheric functioning post-stroke means

that doctors can give a more accurate diagnosis and better treatment.

In all its uses, fMRI technology gives startlingly accurate images and information, which are already

leading to great advances in medical practice and research, saving costs for hospitals and, most

importantly, may significantly improve patient outcomes.

Siemens fMRI technology (here with the use of a MAGNETOM Trio

3 Tesla system) enables researchers to better understand human brain activities, not only for language research, but also for stroke patients.

30

HEALTHCARE – FUTURE

INTEGRATED DIAGNOSTICS

INTERNATIONAL REFERENCE CENTRE TO

RESEARCH INTEGRATED DIAGNOSTICS

Last year, Hospital Clinic de Barcelona began what

promises to be a ground-breaking initiative to functionally

integrate their laboratory diagnostics (in vitro), medical

imaging (in vivo), and healthcare information technology.

Their goal in bringing the disciplines together is to give

their clinicians access to the most comprehensive patient

information possible, and allow for quicker and safer

decision making in all stages of the healthcare continuum.

Since Hospital Clinic de Barcelona is one of the first

hospitals in the world to initiate clinical research programs

on integrated diagnostics, they’ve become an

international reference centre, enhancing our ability to

truly improve the standards of care at the institution.

Many aspects of this initiative break new ground for them.

One of the most exciting is the cross-functional clinical

and management team they have assembled within the

hospital, another step ahead in their organizational model

focused on the patient and translational research. Some

of these disciplines have not collaborated before in

research and process improvement. Now, they’re fully

aligned as a team, ready to embark on rigorously

designed research protocols – pioneers in a collaboration

that has the potential to transform the way their patients

are treated.

Their research team, together with Siemens experts, is

working to develop specific diagnostic practices, starting

in three principal areas: hepatology, gastroenterology,

and foetal medicine. As an example, in liver fibrosis, they

will study how to reduce or replace the number of biopsies

by a comprehensive integrated diagnostic practice that

can be used in the pre-symptomatic stages of disease. With this new research project, the goal is to find a new

non-invasive approach for the precise assessment of liver

cirrhosis. This could be developed by combining

biochemical markers with diagnostic imaging analysis.

“It is my belief that the integration of technology will be the factor that transforms healthcare.” Don Rucker, MD, Chief Medical Officer

Siemens Healthcare USA

“Molecular diagnostics integrated with therapeutics represents a major new opportunity in the era of personalized medicine.” Jared Schwartz, MD, PhD Pathology and Lab Medicine

31

The current method for determination of the level of liver

fibrosis is to undergo a liver biopsy, which is uncomfortable

and can be unsafe for the patient.

In the area of foetal medicine, Hospital Clinic de Barcelona

hopes to combine its knowledge of diagnostic methods

with the technological skills of Siemens to improve quality

of life for the mother and the fetus. Biomarkers, new IT

algorithms, and the development of new imaging methods

for analyzing the fetal brain and heart are the areas of

greatest joint development potential.

In many fields, not just healthcare, complex challenges

demand an interdisciplinary solution. When multiple

disciplines can be leveraged simultaneously with the

adequate technology, the possibilities for real

breakthroughs multiply. This is the case with integrated

diagnostics: the convergence of imaging technology and in

vitro diagnostics – enabled by advanced healthcare

information technology. This will not only mean earlier and

presumably better diagnoses and outcomes; it will also

move the patient through the healthcare system with

increasing efficiency, and help to reduce costs. Three

disciplines, working as one, could radically change

diagnosis and treatment for many chronic diseases.

At Hospital Clinic de Barcelona, this is the vision for the

future of diagnostics.

PATIENT BENEFITS

• Receive the most specific and necessary tests, procedures and therapies according to their health and disease state.

• Have enhanced dialogue with their healthcare provider.

• Play a more active role in their own well-being by gaining easier and earlier access to their diagnostic picture.

CLINICIAN BENEFITS

• Receive the right information, at the right time, to produce the best patient outcome.

• Make the optimal treatment decision sooner based on a complete diagnostic picture.

• Proactively manage patient care, rather than simply treat disease.

32

CONCLUSION

Working at Siemens gave me a whole new perspective to both biomedical engineering and the

healthcare industry. I learnt a lot of things that I think would be useful for me in future. Firstly I

witnessed the working of a big MNC like Siemens which provided me with knowledge about the

hierarchy of a big company, its marketing and sales strategies, its contribution and assistance

in research and development to stay as the pioneer in the field. How one needs to merge

different fields like electrical engineering, IT, biomedical engineering, etc. to make revolutionary

technologies. And how important it is to provide solutions to the simplest problems and hence

keep on innovating. Secondly I also gained a lot in the field of biomedical imaging, which I think

certainly added value to my current education.

Working here also inspired me to start up a company of my own someday in the field of

biomedical engineering.

VIRAJ AGNIHOTRI Second Year Undergraduate,

Biological Sciences and Bioengineering

Indian Institute of Technology Kanpur

BIBLIOGRAPHY

Contains content from

• Healthcare Learning Academy, India

• www.wikipedia.org

• www.siemens.com