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Springer Handbookof Medical Technology
Springer Handbook providesa concise compilation of approvedkey information on methods ofresearch, general principles, andfunctional relationships in physicsand engineering. The world’s lead-ing experts in the fields of physicsand engineering will be assigned byone or several renowned editors towrite the chapters comprising eachvolume. The content is selected bythese experts from Springer sources(books, journals, online content)and other systematic and approvedrecent publications of physical andtechnical information.
The volumes will be designed tobe useful as readable desk referencebook to give a fast and comprehen-sive overview and easy retrieval ofessential reliable key information,including tables, graphs, and bibli-ographies. References to extensivesources are provided.
123
HandbookSpringerof Medical Technology
Rüdiger Kramme, Klaus-Peter Hoffmann,Robert S. Pozos (Eds.)
With 1008 Figures and 139 Tables
EditorsRüdiger KrammeTitisee, Germany
Klaus-Peter HoffmannFraunhofer Institute for Biomedical EngineeringMedical Engineering and NeuroprostheticsSt. Ingbert, Germany
Robert S. PozosSan Diego State UniversityDepartment of BiologySan Diego, CA, USA
ISBN 978-3-540-74657-7 ISBN 978-3-540-74658-4DOI 10.1007/978-3-540-74658-4Springer Heidelberg Dordrecht London New York
Library of Congress Control Number: 2011933994
c© Springer-Verlag Berlin Heidelberg 2011This work is subject to copyright. All rights are reserved, whether the wholeor part of the material is concerned, specifically the rights of translation,reprinting, reuse of illustrations, recitation, broadcasting, reproduction onmicrofilm or in any other way, and storage in data banks. Duplication of thispublication or parts thereof is permitted only under the provisions of theGerman Copyright Law of September 9, 1965, in its current version, andpermission for use must always be obtained from Springer. Violations areliable to prosecution under the German Copyright Law.The use of general descriptive names, registered names, trademarks, etc. inthis publication does not imply, even in the absence of a specific statement,that such names are exempt from the relevant protective laws and regulationsand therefore free for general use.
Production and typesetting: le-tex publishing services GmbH, LeipzigSenior Manager Springer Handbook: Dr. W. Skolaut, HeidelbergTranslation of Chaps. 1, 3–7, 17, 28, 35, 47–51, 54, 58, 60 from German byGrace Hughes on behalf of Translearning GbR, MannheimTypography and layout: schreiberVIS, SeeheimIllustrations: le-tex publishing services GmbH, Leipzig, Hippmann GbR,SchwarzenbruckCover design: eStudio Calamar Steinen, BarcelonaCover production: WMXDesign GmbH, Heidelberg
Printed on acid free paper
Springer is part of Springer Science+Business Media (www.springer.com)
89/3180/YL 5 4 3 2 1 0
(eBook)
V
Preface
This Springer Handbook is an overview of the ex-panding and exciting field of medical technology inwhich the reader will find a modern presentation ofthe relevant aspects of research, design, manufactur-ing, and application of different medical devices. Thefollowing components: Basics, Functional DiagnosticsDevices, Monitoring, Medical Imaging, TherapeuticDevices, Rehabilitation, Medical Information Process-ing, Telemedicine, Equipment and Tools cover themajor aspects of this field.
The handbook was compiled to be an indispensableresource for professionals working directly or indirectlywith medical systems and appliances. Just as impor-tantly, it was organized for graduate and postgraduatestudents in hospital management, medical engineering,and medical physics.
Medical technology has a long and productive tra-dition of developing medical devices, and innovativeapproaches to solve critical problems in medicine, bi-ology, and environmental sciences. Hence, biomedicalengineering is a rapidly developing field, which exem-plifies multidisciplinary approaches such as biotechnol-ogy, microsystems technology and telematics. Biomed-ical engineers develop devices and systems whichultimately contribute to the identification, treatment,abatement and monitoring of diseases and to the com-pensation of disabilities. The use of modern diagnosticmethods enables the early and safe identification of nu-merous diseases and improving therapeutic outcomes.Using engineering methods to address medical prob-lems will foster additional breakthroughs in clinicaltreatment and management.
The transfer of ideas from basic research and pro-totyping to the final medical product, including the
methodological questions of application requires con-tinued cooperation between teams. The result of theinteraction of basic and clinical medical sciences, in-formation technology, engineering, materials science,and cell biology will open up undreamed-of possibili-ties in diagnostics and therapy. Challenges include 4-Dimaging, e.g. for beating heart diagnostics, coupling ofmicrosystems to neurons, e.g. neural prostheses, the ap-plication of new biomaterials with surface modificationsat the nanoscale, e.g. for the fabrication of a lifelongstable joining of hip prostheses, and the computer mod-eling of a virtual patient for the verification of diagnosisand direction of therapy.
Protection of patients, cost reduction and the con-sideration of progress in medicine as well as thetechnological state-of-the-art are significant challengesfor the development of medical products. Hopefully thisSpringer Handbook will assist in the continued develop-ment of new medical products that will enhance the wellbeing of patients.
The editors would like to thank the authors for theirfruitful, successful and collegial cooperation. It wasa pleasure for us to collect views from the differentfields of medical technology and bring them togetherin the handbook. Special thanks to Dr. Werner Skolaut,Senior Manager Springer Handbooks, and Dr. ThomasDitzinger, Senior Editor Engineering/Applied Sciences,from Springer publishing for their time, help and kindsupport.
May 2011Rüdiger Kramme TitiseeKlaus-Peter Hoffmann St. IngbertRobert S. Pozos San Diego
VII
About the Editors
Rüdiger Kramme, Graduate Engineer, studied Biomedical and Hospital Engineeringas well as Economics in Gießen and Freiburg, Germany. After his studies, he acquiredseveral years of professional experience in sales, marketing and human resources de-velopment in the medical device industry for consumer and investment capital goods.Since 1993 he is working for the German Federal State of Baden-Württemberg andthe German Federal Armed Forces, where he is involved in planning and project de-velopment of University Hospitals and Military Medical Facilities in Germany andabroad. He is a lecturer for Medical Engineering at the University of Applied Sciencesin Gießen, Germany. Rüdiger Kramme has authored numerous scientific publicationsin magazines and books, and is the founder and editor of the Springer standard workMedizintechnik, which will be published in its fourth edition in 2011, as well as theSpringer Dictionary Technische Medizin.
Klaus-Peter Hoffmann received his Doctorate degree in Biomedical Engineeringfrom the University of Technology in Ilmenau, Germany, in 1987. He is currentlyProfessor of Biomedical Engineering at the University of Applied Sciences in Saar-brueck, and Head of the Department of Medical Engineering and Neuroprostheticsat the Fraunhofer Institute for Biomedical Engineering in St. Ingbert. His main re-search interests include methods and devices of Clinical Neurophysiology especiallyNeuromonitoring and saccadic eye movement as well as the use of Microsystems inmedicine especially sensors and actuators for Neuroprostheses. He is also active in thefield of cognitive technical systems. He has coordinated various European and nationalresearch projects, has published more than 200 journal papers, conference papers andbook chapters. He is member of several scientific societies as well as in the advisoryboard of the journal Das Neurophysiologie-Labor. Since 2004, Professor Hoffmannhas led the Expert Group Neuroprosthetics in the Initiative Micromedicine of of theGerman Association for Electrical, Electronic & Information Technologies (VDE). Heis also member of the Technical Committee on Cardiopulmonary Systems of the IEEEEngineering in Medicine and Biology Society.
Robert Pozos, Professor of Biology at San Diego State University, has been activelyengaged in numerous studies utilizing various biomedical technologies to study humanperformance in extreme environments. His expertise extends to motor control studiesin which he has two patents dealing with quantification of fatigue generated duringtyping using dynamic finger force measurements. His current studies deal with thequantification of surface electromyographic signals during various athletic events uti-lizing wifi technology. In addition he is continuing his studies that combine the use ofNIRS measurements with EMG signals during movement.
IX
List of Authors
Dino AccotoUniversità Campus Bio-Medico di Roma
CIR – Center for Integrated Research
Via A. Del Portillo
00128 Rome, Italy
e-mail: [email protected]
Albert J. AugustinStädtisches Klinikum Karlsruhe
Augenklinik
Moltkestr. 90
76133 Karlsruhe, Germany
e-mail: [email protected]
Natasha Avilae-medicis
26 rue George Sand
75016 Paris, France
e-mail: [email protected]
Michael BatemanUniversity of Minnesota
Department of Biomedical Engineering and
Surgery
420 Delaware St. SE
Minneapolis, MN 55455, USA
e-mail: [email protected]
Andreas BermannSiemens Healthcare
Imaging and Therapy Division, SYNGO
Henkestr. 127
91052 Erlangen, Germany
e-mail: [email protected]
Ulrich BöcklerSorin Group Deutschland GmbH
Lindberghstr. 25
80939 München, Germany
e-mail: [email protected]
Armin BolzKarlsruhe Institute of Technology
Institute for Biomedical Engineering
Kaiserstr. 12
76128 Karlsruhe, Germany
e-mail: [email protected]
Jörn BorgertPhilips Technologie GmbH Forschungslaboratorien
Tomographic Imaging Group
Röntgenstr. 24–26
22335 Hamburg, Germany
e-mail: [email protected]
Michael BornSan Diego State University
Department of Biology
5500 Campanile Drive
San Diego, CA 92182, USA
e-mail: [email protected]
Guenther BraunUniversity Medical Center Freiburg
Paediatrics and Adolescent Medicine
Mathildenstr. 1
79106 Freiburg, Germany
e-mail: [email protected]
Dirk BüchelMedical Faculty of Tübingen
Ernst-Simon-Str. 16
72072 Tübingen, Germany
e-mail: [email protected]
Thorsten M. BuzugUniversity of Lübeck
Institute of Medical Engineering
Ratzeburger Allee 160
23538 Lübeck, Germany
e-mail: [email protected]
X List of Authors
Marco CapogrossoScuola Superiore Sant Anna
ARTS lab
Piazza Martiri della Liberta, 33
56100 Pisa, Italy
e-mail: [email protected]
Peter H. CossmannMed Tech Consulting
Säntisstr. 10
5430 Wettingen, Switzerland
e-mail: [email protected]
Andreas DemosthenousUniversity College London
Electronic and Electrical Engineering
Torrington Place
London, WC1E 7JE, UK
e-mail: [email protected]
Thomas M. DesernoRWTH Aachen University
Pauwelsstr. 30
52057 Aachen, Germany
e-mail: [email protected]
Nick DonaldsonUniversity College London
Medical Physics & Bioengineering
Gower St.
London, WC1E 6BT, UK
e-mail: [email protected]
William K. DurfeeUniversity of Minnesota
Department of Mechanical Engineering
111 Church St SE
Minneapolis, MN 55455, USA
e-mail: [email protected]
Günter Edlingerg.tec medical engineering GmbH
Herbersteinstr. 60
8020 Graz, Austria
e-mail: [email protected]
Amir EftekharImperial College London,
South Kensington Campus
Centre for Bio-Inspired Technology
London, SW7 2AZ, UK
e-mail: [email protected]
Mariana FernandesUniversity of Minho
Department of Industrial Electronics,
DEI – Campus de Azurém
4800-058 Guimarães, Portugal
e-mail: [email protected]
Eduardo FernandezUniversidad Miguel Hernández
Bioengineering Institute
Avenida de la Universidad, s/n
03202 Elche, Spain
e-mail: [email protected]
Fabiola Fernandez-GutierrezUniversity of Dundee
Institute for Medical Science and Technology
1 Wurzburg Loan, Dundee Medipark
Dundee, DD2 1FD, UK
e-mail: [email protected]
Celso P. FigueiredoUniversity of Minho, Campus de Azurém
Department of Industrial Electronics
4800-058 Guimarães, Portugal
e-mail: [email protected]
Harald FischerCreamedix GmbH
Königsberger Str. 2
76356 Weingarten, Germany
e-mail: [email protected]
Martin R. FischerPrivate University Witten/Herdecke gGmbH
Fakultät für Gesundheit
Alfred-Herrhausen-Str. 50
58448 Witten, Germany
e-mail: [email protected]
List of Authors XI
Óscar S. GamaUniversidade do Minho, Campus de Gualtar
Departamento de Informática
4710-057 Braga, Portugal
e-mail: [email protected]
Stephan GarbeUniversity Hospital of Bonn
Radiology Department
Sigmund-Freud-Str. 25
53105 Bonn, Germany
e-mail: [email protected]
Belinda GarnerImperial College London,
South Kensington Campus
Institute of Biomedical Engineering
London, SW7 2AZ, UK
e-mail: [email protected]
Armin GärtnerIngenieurbüro für Medizintechnik
Edith-Stein-Weg 8
40699 Erkrath, Germany
e-mail: [email protected]
Bernhard GleichPhilips Technologie GmbH
Tomographic Imaging Group
Röntgenstr. 24–26
22335 Hamburg, Germany
e-mail: [email protected]
Rudolf GötzAloka GmbH
Halskestr. 25
47877 Willich, Germany
e-mail: [email protected]
Christoph Gugerg.tec medical engineering GmbH, Guger
Technologies OG
Sierningstr. 14
4521 Schiedlberg, Austria
e-mail: [email protected]
Eugenio GuglielmelliUniversita’ Campus Bio-Medico
CIR – Center For Integrated Research
Via Alvaro Del Portillo 21
00128 Rome, Italy
e-mail: [email protected]
Martin HaagHeilbronn University
Medical Informatics
Max-Planck-Str. 39
74081 Heilbronn, Germany
e-mail: [email protected]
Reiner HaagLawton GmbH & Co. KG
Württemberger Str. 23
78567 Fridingen, Germany
e-mail: [email protected]
Peter HaasUniversity of Applied Sciences and Arts Dortmund
Medical Informatics
Emil-Figge-Str. 42
44147 Dortmund, Germany
e-mail: [email protected]
Andreas HahnSorin Group Deutschland GmbH
General Management
Lindberghstr. 25
80939 München, Germany
e-mail: [email protected]
Sibylle HanusTextile Research Institute Thuringia-Vogtland
Textile Structures and Materials
Zeulenrodaer Str. 42
07973 Greiz, Germany
e-mail: [email protected]
Michael HeinleinMednovo Medical Software Solutions GmbH
Hohenzollerndamm 150
14199 Berlin, Germany
e-mail: [email protected]
XII List of Authors
Ewald HennigDeutsches Herzzentrum Berlin
Augustenburger Platz 1
13353 Berlin, Germany
e-mail: [email protected]
Roland HentschelUniversitätsklinikum Freiburg
Neonatologie/Intensivmedizin, Zentrum für
Kinder- und Jugendmedizin
Mathildenstr. 1
79106 Freiburg, Germany
e-mail: [email protected]
Roland HetzerDeutsches Herzzentrum Berlin
Augustenburger Platz 1
13353 Berlin, Germany
e-mail: [email protected]
Lothar HeuserKlinikum der Ruhr-Universität Bochum
Institut für Diagnostische & Interventionelle
Radiologie, Knappschaftskrankenhaus
In der Schornau 23–25
44892 Bochum, Germany
e-mail: [email protected]
Ullrich HieronymiDräger Medical Deutschland GmbH
Moislinger Allee 53–55
23558 Lübeck, Germany
e-mail: [email protected]
Robert HitchcockUniversity of Utah
Bioengineering
Salt Lake City, UT 84112, USA
e-mail: [email protected]
Gerhard HoffmannOrangedental GmbH & Co KG
Aspachstr. 11
88400 Biberach, Germany
e-mail: [email protected]
Klaus-Peter HoffmannFraunhofer Institute for Biomedical Engineering
Medical Engineering and Neuroprosthetics
Emsheimer Str. 48
66386 St. Ingbert, Germany
e-mail: [email protected]
Gerald C. HolstJCD Publishing Company
Winter Park, FL 32789, USA
e-mail: [email protected]
Sebastian HothUniversity of Heidelberg
ENT Hospital – Audiology
Im Neuenheimer Feld 400
69120 Heidelberg, Germany
e-mail: [email protected]
Stephen A. HowardUniversity of Minnesota
Department of Biomedical Engineering and
Surgery
420 Delaware St. SE
Minneapolis, MN 55455, USA
e-mail: [email protected]
Bernhard HugKLS Martin GmbH + Co. KG
Am Gansacker 1b
79224 Umkirch, Germany
e-mail: [email protected]
Paul A. IaizzoUniversity of Minnesota
Department of Surgery
420 Delaware St. SE
Minneapolis, MN 55455, USA
e-mail: [email protected]
Erwin ImmelUniversity of Dundee
Institute for Medical Science and Technology
Wurzburg Loan
Dundee, DD2 1FD, UK
e-mail: [email protected]
List of Authors XIII
Klaus-Martin IrionKarl Storz GmbH & Co. KG
Mittelstr. 8
78532 Tuttlingen, Germany
e-mail: [email protected]
Heinz-Michael JustKlinikum Nürnberg
Institute of Hospital Epidemiology, Medical
Microbiology and Infectious Diseases
Prof.-Ernst-Nathan-Str. 1
90419 Nürnberg, Germany
e-mail: [email protected]
Daniel W. KauffUniversity Medicine of the Johannes Gutenberg
University Mainz
Department of General and Abdominal Surgery
Langenbeckstr. 1
55131 Mainz, Germany
e-mail: [email protected]
Rüdiger KlarUniversitätsklinik Freiburg
Institut für Medizinische Biometrie und
Medizinische Informatik
Stefan-Meier-Str. 26
79104 Freiburg, Germany
e-mail: [email protected]
Werner KneistUniversity Medicine of the Johannes Gutenberg
University Mainz
Department of General and Abdominal Surgery
Langenbeckstr. 1
55131 Mainz, Germany
e-mail: [email protected]
Klaus P. KochUniversity of Applied Sciences Trier
Department of Engineering
54293 Schneidershof, Trier, Germany
e-mail: [email protected]
Heike KrammeFuchsweg 14
79822 Titisee, Germany
e-mail: [email protected]
Rüdiger KrammeFuchsweg 14
79822 Titisee, Germany
e-mail: [email protected]
Ursula KrechelUniversity Clinic Freiburg
IT-Department
Robert-Koch-Str. 1
79106 Freiburg, Germany
e-mail: [email protected]
Harald KronbergAm Hohen Rain 6
64720 Michelstadt, Germany
e-mail: [email protected]
Klaus A. KuhnTechnische Universität München (TUM)
Institute of Medical Statistics and Epidemiology
München, Germany
e-mail: [email protected]
Bernhard KulikMaquet GmbH & Co. KG
Kehler Str. 31
76437 Rastatt, Germany
e-mail: [email protected]
Timothy G. LaskeMedtronic, Inc.
8200 Coral Sea St. NE.
Mounds View, MN 55112, USA
e-mail: [email protected]
Martin LeonhardKarl Storz GmbH & Co. KG
Research and Technology
Mittelstr. 8
78532 Tuttlingen, Germany
e-mail: [email protected]
Xiao LiuUniversity College London
Department of Electronic and Electrical
Engineering
Torrington Place
London, WC1E 7JE, UK
e-mail: [email protected]
XIV List of Authors
Martin MaierPhilips Healthcare
Hewlett-Packard-Str. 2
71034 Böblingen, Germany
e-mail: [email protected]
Giovanni MaioUniversity of Freiburg
Institute of Bioethics and History of Medicine
Stefan-Meier-Str. 26
79104 Freiburg, Germany
e-mail: [email protected]
Albrecht MalkmusGE Medical Systems Information Technologies
Munzinger Str. 5
79111 Freiburg, Germany
e-mail: [email protected]
Kei MasaniToronto Rehabilitation Institute
Lyndhurst Centre
520 Sutherland Drive
Toronto, Ontario M4G 3V9, Canada
e-mail: [email protected]
Ulrich MaternwwH-c GmbH
Ernst-Simon-Str. 16
72072 Tübingen, Germany
e-mail: [email protected]
John McNultySan Diego State University
Department of Biology
5500 Campanile Drive
San Diego, CA 92182, USA
e-mail: [email protected]
Andreas MelzerUniversity Dundee
IMSaT
1 Würzburg Loan
Dundee, Scottland DD2 1FD, UK
e-mail: [email protected]
Paulo M. MendesUniversity of Minho, Campus de Azurém
Department of Industrial Electronics
4800-058 Guimarães, Portugal
e-mail: [email protected]
Silvestro MiceraETH Zürich, ETL K 10.1
Institut für Automatik
Physikstr. 3
8092 Zürich, Switzerland
e-mail: [email protected]
Kostis MichelakisImperial College London,
South Kensington Campus
Institute of Biomedical Engineering
London, SW7 2AZ, UK
e-mail: [email protected]
Uwe MöhringTextile Research Institute Thuringia-Vogtland
Zeulenrodaer Str. 42–44
07973 Greiz, Germany
e-mail: [email protected]
Wolfgang Müller-WittigNanyang Technological University (NTU)
Fraunhofer IDM@NTU
Nanyang Avenue
639798 Singapore
e-mail: [email protected]
Andreas NeudeckTextile Research Institute Thuringia-Vogtland
Zeulenrodaer Str. 44
07973 Greiz, Germany
e-mail: [email protected]
Wolfgang R. NitzSiemens AG Healthcare Sector
Allee am Röthelheimpark 2
91052 Erlangen, Germany
e-mail: [email protected]
Heike OschatzTextile Research Institute Thuringia-Vogtland
Textile Structures and Materials
Zeulenrodaer Str. 42
07973 Greiz, Germany
e-mail: [email protected]
List of Authors XV
Ernst PelikanUniversity Medical Center Freiburg
Hospital Computer Department
Agnesenstr. 6–8
79106 Freiburg, Germany
e-mail: [email protected]
Thomas PeynDräger Medical AG & Co. KG
Department for Respiratory Care
Lübeck, Germany
e-mail: [email protected]
Doris PommiSiemens Healthcare
Siemensstr. 1
91301 Forchheim, Germany
e-mail: [email protected]
Milos R. PopovicUniversity of Toronto
Rehabilitation Engineering Laboratory, Institute of
Biomaterials and Biomedical Engineering
164 College St.
Toronto, Ontario M5S 3G9, Canada
e-mail: [email protected]
Robert S. PozosSan Diego State University
Department of Biology
5500 Campanile Dr.
San Diego, CA 92182-4616, USA
e-mail: [email protected]
Anna Radomska-Botelho MonizImperial College London,
South Kensington Campus
Institute of Biomedical Engineering
London, SW7 2AZ, UK
e-mail: [email protected]
Stanisa RaspopovicScuola Superiore Sant Anna
ARTS lab
Piazza Martiri della Liberta, 33
56100 Pisa, Italy
e-mail: [email protected]
Annette ReinhardtKlinikum Nürnberg
Institute of Hospital Epidemiology
Prof.-Ernst-Nathan-Str. 1
90419 Nürnberg, Germany
e-mail:
Cristiano RizzoMicromed S.p.A.
Via Giotto, 2
31021 Mogliano Veneto (TV), Italy
e-mail: [email protected]
Eckhard RoggenkampKlinikum Nuremberg
Institute of Hospital Epidemiology
Prof.-Ernst-Nathan-Str. 1
90419 Nürnberg, Germany
e-mail:
Christopher RolfesUniversity of Minnesota
Department of Biomedical Engineering and
Surgery
420 Delaware St. SE
Minneapolis, MN 55455, USA
e-mail: [email protected]
Christian RotschFraunhofer Institute for Machine Tools and
Forming Technology IWU
Department Adaptronics and Acoustics
Nöthnitzer Str. 44
01187 Dresden, Germany
e-mail: [email protected]
Georg-Friedemann RustRendoscopy AG
Grubmühlerfeldstr. 54
82131 Gauting, Germany
e-mail: [email protected]
Christina SampognaUniversity of Cambridge
Newmarket, Suffolk C88 7YY, UK
e-mail: [email protected]
XVI List of Authors
Gregor SchaefersMR:comp GmbH
Buschgrundstr. 33
45894 Gelsenkirchen, Germany
e-mail: [email protected]
Rolf M. SchlegelmilchSMT medical GmbH & Co.
Im Kreuz 9
97076 Würzburg, Germany
e-mail: [email protected]
Oliver ScholzHTW Saarland,
University of Applied Sciences
Goebenstr. 40
66117 Saarbrücken, Germany
e-mail: [email protected]
Frank SchönAloka Holding Europe AG
Steinhauserstr. 74
6300 Zug, Switzerland
e-mail: [email protected]
Arthur SchultzHannover Medical School
EEG Monitoring Research Group
Carl-Neuberg-Str. 1
30625 Hannover, Germany
e-mail: [email protected]
Barbara SchultzHannover Medical School
Informatik/Biometrie
Podbielskistr. 380
30659 Hannover, Germany
e-mail: [email protected]
Dirk SchulzeDDZ Breisgau
Kaiser-Joseph-Str. 263
79098 Freiburg, Germany
e-mail: [email protected]
Wilhelm SchütteKreiskrankenhaus Gummersbach, Academic
Teaching Hospital of the University of Cologne
Department of Medical Radiation Physics
Wilhelm-Breckow-Allee 20
51643 Gummersbach, Germany
e-mail: [email protected]
Danny SchwabeTextile Research Institute Thuringia-Vogtland
Zeulenrodaer Str. 44
07973 Greiz, Germany
e-mail: [email protected]
Sanjiv SharmaImperial College London,
South Kensington Campus
Institute of Biomedical Engineering
London, SW7 2AZ, UK
e-mail: [email protected]
Erich SiegelDräger Medical AG & Co. KG
Moislinger Allee 53–55
23558 Lübeck, Germany
e-mail: [email protected]
Florian SolzbacherUniversity of Utah
Electrical and Computer Engineering
Salt Lake City, UT 84112, USA
e-mail: [email protected]
Silvia SterziUniversità Campus Bio-Medico
Physical Medicine and Rehabilitation
Via Alvaro del Portillo 21
00128 Rome, Italy
e-mail: [email protected]
Wilfried StorzGebrüder Martin GmbH & Co. KG
Ludwigstaler Str. 132
78532 Tuttlingen, Germany
e-mail: [email protected]
List of Authors XVII
Dirk SunderbrinkSiemens AG – Healthcare Sector
Imaging and Therapy Department
Hartmannstr. 16
91301 Forchheim, Germany
e-mail: [email protected]
Hajo TanckMednovo Medical Software Solutions GmbH
Hohenzollerndamm 150
14199 Berlin, Germany
e-mail: [email protected]
Prashant TathireddyUniversity of Utah
Electrical and Computer Engineering
Salt Lake City, UT 84112, USA
e-mail: [email protected]
Rachel ToomeyUniversity of Dundee
Institute for Medical Science and Technology
1 Wurzburg Loan, Dundee Medipark
Dundee, DD2 1FD, UK
e-mail: [email protected]
Iasonas F. TriantisSensors Systems and Circuits Research Group
Department of Electronic and Electrical
Engineering
University College London
London, WC1E 7JE, UK
e-mail: [email protected]
Jakub TrzebinskiImperial College London,
South Kensington Campus
Institute of Biomedical Engineering
London, SW7 2AZ, UK
e-mail: [email protected]
Friedrich UeberleHamburg University of Applied Sciences
Department of Life Sciences/Biomedical
Technology
Lohbrügger Kirchstr. 65
21033 Hamburg, Germany
e-mail: [email protected]
Hans-Peter UhligÖsterreicher Str. 69a
01279 Dresden, Germany
e-mail: [email protected]
Jörg VienkenFresenius Medical Care
Else Kroener Str. 1
61342 Bad Homburg, Germany
e-mail: [email protected]
Udo VogesKarlsruher Institut für Technologie
Institut für Angewandte Informatik
Hermann-von-Helmholtz-Platz 1
76344 Eggenstein-Leopoldshafen, Germany
e-mail: [email protected]
Birgit WackerPhilips Healthcare
Hewlett-Packard Str. 2
71034 Böblingen, Germany
e-mail: [email protected]
Golam Abu ZakariaHospital of the University of Cologne
Department of Medical Radiation Physics
Wilhelm-Breckow-Allee 20
51643 Gummersbach, Germany
e-mail: [email protected]
Christian ZapfSiemens AG – Healthcare Sector
Imaging and Therapy – SYNGO
Hartmannstr. 16
91052 Erlangen, Germany
e-mail: [email protected]
Frank ZgodaLaser- und Medizin-Technologie GmbH
Fabeckstr. 60–62
14195 Berlin, Germany
e-mail: [email protected]
Loredana ZolloUniversità Campus Bio-Medico di Roma
Laboratory of Biomedical Robotics and
Biomicrosystems
Via Álvaro Del Portillo, 21
00128 Rome, Italy
e-mail: [email protected]
XIX
Contents
List of Abbreviations ................................................................................. XXXVII
Part A Medical Technology Basics
1 Technology in Medicine:Its Role and Significance in Terms of Health PolicyRüdiger Kramme, Heike Kramme .............................................................. 31.1 A Short History .............................................................................. 31.2 Early Breakthroughs of Medical Technology .................................... 31.3 Analog to Digital ........................................................................... 41.4 Health Policy ................................................................................. 51.5 New Key Areas............................................................................... 51.6 Innovation Versus Financial Resources ........................................... 6
2 Medicine Is More Than Applied Technology for Human BeingsGiovanni Maio ......................................................................................... 72.1 Technology Suggests Feasibility and Controllability ......................... 72.2 Technology Knows No Bounds ........................................................ 82.3 Technology Is Unable to Answer the Question of Meaning ............... 92.4 Technology Alone Does Not Make Medicine Humane ....................... 9References .............................................................................................. 10
3 Hygiene in Medical TechnologyHeinz-Michael Just, Eckhard Roggenkamp, Annette Reinhardt .................. 113.1 Background .................................................................................. 123.2 Causes of Infection ........................................................................ 133.3 Vaccinations ................................................................................. 133.4 Disinfection Methods ..................................................................... 143.5 Sterilization Methods..................................................................... 213.6 Hygiene of Noninvasive Technology Equipment .............................. 253.7 Hygiene of Invasive Technology Equipment .................................... 263.8 Practical Examples......................................................................... 263.9 Regulations ................................................................................... 31References .............................................................................................. 33
4 Technical Safety of Electrical Medical Technology Equipmentand SystemsRüdiger Kramme, Hans-Peter Uhlig .......................................................... 354.1 General Information Regarding the Safety of Technical Systems ....... 364.2 Attaining Safety in Medical Institutions .......................................... 364.3 Minimum Requirements for ME Equipment ..................................... 37
XX Contents
4.4 Areas Used for Medical Purposes .................................................... 404.5 Electrical Systems According to the Nature of the Connection
to Earth ........................................................................................ 424.6 Protection Against Shock Currents .................................................. 424.7 Power Supply ................................................................................ 444.8 Power Sources for Safety Purposes with Accumulators ..................... 444.9 Final Circuits and Plug Sockets ....................................................... 454.10 Static Electricity ............................................................................. 454.11 Electromagnetic Compatibility ........................................................ 464.12 Conclusions ................................................................................... 47References .............................................................................................. 47
5 Quality Management in Medical TechnologyAlbrecht Malkmus .................................................................................... 495.1 Objectives of a Quality Management System ................................... 495.2 Elements of a Quality Management System ..................................... 545.3 Organization of a Quality Management System ............................... 545.4 Implementation of a QMS .............................................................. 565.5 Product Quality ............................................................................. 575.6 Concluding Remarks ...................................................................... 57References .............................................................................................. 58
6 Usability of Medical DevicesUlrich Matern, Dirk Büchel........................................................................ 596.1 What Is Usability? .......................................................................... 596.2 Usability in Medical Technology – Obligation or Opportunity? .......... 606.3 Usability in Medical Technology – Why?.......................................... 616.4 Development of Usable Devices – How Is this Done? ....................... 626.5 Testing of Usable Devices – How Is this Done?................................. 646.6 Assessment of Usability ................................................................. 676.7 Usability Development, Testing, and Assessment – An Example ....... 67References .............................................................................................. 70
Part B Functional Diagnostics Devices
7 Basic Diagnostics in CardiologyRüdiger Kramme...................................................................................... 757.1 Electrocardiography....................................................................... 757.2 Electrocardiograph Equipment Technology and PC ECG .................... 767.3 ECG Methods ................................................................................. 797.4 Lead Systems ................................................................................ 807.5 Methodological Notes .................................................................... 837.6 The Diagnostic Value of the ECG...................................................... 837.7 Complications ............................................................................... 847.8 Technical Safety Aspects of ECG Systems .......................................... 847.9 Long-Term ECG .............................................................................. 84
Contents XXI
7.10 Long-Term ECG Systems ................................................................. 857.11 Computer-Based Assessment ......................................................... 857.12 Heart Rate Variability and Heart Rate Turbulence ............................ 877.13 Indications for Long-Term Electrocardiography ............................... 877.14 The Significance of the Long-Term ECG ........................................... 877.15 The Exercise ECG ............................................................................ 887.16 Equipment Technology .................................................................. 887.17 Reduced Exercise ECG Leads ........................................................... 897.18 Automatic ST Measuring Programs .................................................. 907.19 Exercise Test .................................................................................. 907.20 Methodological Notes .................................................................... 937.21 The Diagnostic Value of Ergometry .................................................. 937.22 Indications ................................................................................... 937.23 Abort Criteria and Safety Measures ................................................. 937.24 Technical Safety Aspects................................................................. 947.25 Notes on Planning ......................................................................... 94Further Reading ...................................................................................... 94
8 Pulmonary Function TestingRolf M. Schlegelmilch, Rüdiger Kramme .................................................... 958.1 Spirometry .................................................................................... 958.2 Advanced Cardiopulmonary Function Testing .................................. 105References .............................................................................................. 116
9 Devices and Methods in Clinical NeurophysiologyKlaus-Peter Hoffmann, Ursula Krechel ...................................................... 1199.1 Basics ........................................................................................... 1199.2 Electroencephalograph .................................................................. 1299.3 Electromyograph ........................................................................... 138Further Reading ...................................................................................... 157
10 Sleep Diagnostic SystemsKlaus-Peter Hoffmann, Robert S. Pozos .................................................... 15910.1 Function and Application .............................................................. 15910.2 Sleep Diagnostics, Sleep Laboratories, and Sleep Apneas ................. 16010.3 Technology ................................................................................... 16210.4 Sleep Diagnostic Procedures ........................................................... 16510.5 Signal Recording and Signal Processing .......................................... 16610.6 Fields of Application ...................................................................... 17110.7 Methodical Instructions ................................................................. 17210.8 Medical Significance of Sleep Diagnostics ....................................... 17310.9 Therapy ........................................................................................ 17510.10 Safety Aspects ............................................................................... 17610.11 Planning Advice ............................................................................ 176Further Reading ...................................................................................... 176
XXII Contents
11 NystagmographyKlaus-Peter Hoffmann, Eduardo Fernandez .............................................. 17911.1 Application ................................................................................... 17911.2 Eye Movements ............................................................................. 18011.3 Technology and Methods ............................................................... 18111.4 Methods ....................................................................................... 18411.5 Signal Recording and Signal Processing .......................................... 18711.6 Medical Significance ...................................................................... 18711.7 Safety Aspects ............................................................................... 18811.8 Spatial Planning ............................................................................ 188References .............................................................................................. 189
12 AudiometrySebastian Hoth ........................................................................................ 19112.1 Physical, Technical and Physiological Bases of Audiometry .............. 19112.2 Behavioral Audiometric Assessment ............................................... 20012.3 Objective Audiometric Assessment .................................................. 21212.4 Technical Hearing Devices .............................................................. 228References .............................................................................................. 242
13 Measurement Techniques in OphthalmologyAlbert J. Augustin .................................................................................... 24513.1 Measurement of Intraocular Pressure ............................................. 24613.2 Optical Coherence Tomography (OCT)............................................... 24713.3 Laser-Scanning Tomography
with the Heidelberg Retina Tomograph (HRT) .................................. 24913.4 Nerve Fiber Polarimetry with GDx ................................................... 25113.5 The Rostock Cornea Module (Confocal Laser Microscope) .................. 25213.6 Automatic Refractometry ............................................................... 25213.7 Visually Evoked Potential (VEP) ....................................................... 25313.8 The Ganzfeld ERG (Ganzfeld Electroretinogram) ............................... 25413.9 Pattern Electroretinography (Pattern ERG, PERG) ............................. 25713.10 Multifocal ERG (mfERG) .................................................................. 25913.11 Electrooculograms (EOG) ................................................................ 26013.12 Adaptometry ................................................................................. 26113.13 Aberrometry (Wavefront Analysis)................................................... 26113.14 Keratometry .................................................................................. 26313.15 Retinoscopy or Skiascopy ............................................................... 26313.16 Ultrasound .................................................................................... 26313.17 Corneal Topography ....................................................................... 26513.18 The Orbscan .................................................................................. 26513.19 Scheimpflug Examination .............................................................. 26713.20 Fluorescence Angiography of the Retina (Sodium-Fluorescein) ........ 26713.21 Fluorescence Angiography of the Retina (Indocyanine Green) .......... 26913.22 Visual Field Measurement (Perimetry) ............................................. 26913.23 Exophthalmometry ........................................................................ 271References .............................................................................................. 271
Contents XXIII
14 Functional Force Assessment of Skeletal MusclesPaul A. Iaizzo, William K. Durfee .............................................................. 27314.1 The Need for Skeletal Muscle Force Assessment ............................... 27314.2 Manual Muscle Strength Testing ..................................................... 27514.3 Advanced Muscle Assessment Methods ........................................... 27814.4 Stimulated Muscle Force Assessment .............................................. 27914.5 Stimulated Muscle Force Assessment in Animal Models ................... 28314.6 Conclusion .................................................................................... 285References .............................................................................................. 285
Part C Medical Imaging
15 Digital RadiographyLothar Heuser .......................................................................................... 29115.1 Historical Background .................................................................... 29115.2 From Analog to Digital Image ......................................................... 29215.3 Digital Imaging Systems in Radiology ............................................. 29615.4 Digital Image Processing ................................................................ 30515.5 Image Communication and Archiving ............................................. 307References .............................................................................................. 309
16 Computed TomographyThorsten M. Buzug ................................................................................... 31116.1 Background .................................................................................. 31116.2 Milestones of Computed Tomography ............................................. 31316.3 Computed Tomography Technology ................................................ 31816.4 Image Reconstruction .................................................................... 32316.5 Scan Planning and Applications ..................................................... 32916.6 Dose ............................................................................................. 33516.7 Special System Designs .................................................................. 338References .............................................................................................. 341
17 Ultrasound DiagnosticsRudolf Götz, Frank Schön ......................................................................... 34317.1 Basic Physical Principles ................................................................ 34417.2 Visualization of the Blood Flow and Vascular System ....................... 34817.3 Equipment Technology .................................................................. 35017.4 Three-Dimensional Ultrasound (3-D, Real-Time 3-D) ...................... 36017.5 Operation of an Ultrasound Unit .................................................... 367Further Reading ...................................................................................... 367
18 Medical Infrared ImagingGerald C. Holst, Thorsten M. Buzug ........................................................... 36918.1 Background .................................................................................. 36918.2 Infrared System Design .................................................................. 37018.3 Infrared Physics ............................................................................ 372
XXIV Contents
18.4 IR Imaging in Medical Applications................................................. 37318.5 Specific Applications ...................................................................... 37418.6 Limitations of IR Imaging in Medical Applications ........................... 37718.7 Summary ...................................................................................... 377References .............................................................................................. 378
19 EndoscopyMartin Leonhard, Klaus-Martin Irion ........................................................ 37919.1 Basics ........................................................................................... 38019.2 Endoscopes and Endoscopic Accessories ......................................... 38219.3 Integrated Operating Theaters........................................................ 39119.4 Medical Applications ..................................................................... 39319.5 Tissue Differentiation .................................................................... 39419.6 Further Future Developments ......................................................... 398References .............................................................................................. 402
20 Cone-Beam Computed Tomography and NavigationDirk Schulze, Gerhard Hoffmann............................................................... 40520.1 Technical Background of Dental Digital Volume Tomography ........... 40520.2 Areas of Application of Dental CBCT................................................. 408References .............................................................................................. 413
21 Interventional Radiology – AngiographyDoris Pommi ............................................................................................ 41721.1 Definition of Digital Subtraction Angiography ................................. 41721.2 Application Range for Angiography ................................................ 41921.3 Advantages of Interventional Radiology Procedures ........................ 42021.4 Trends of Development .................................................................. 420Further Reading ...................................................................................... 421
22 Near-Infrared Spectroscopy (NIRS)John McNulty, Michael Born, Robert S. Pozos............................................. 42322.1 NIRS – Technical ............................................................................ 42322.2 NIRS Technology: Engineering Aspects ............................................ 42522.3 Instrumentation and Equipment .................................................... 42722.4 New Developments: Multidepth Differential Approach .................... 43022.5 Clinical Application and Study of NIRS ............................................ 43122.6 Does Skin Blood Flow Affect NIRS Measurements? ............................ 43322.7 Future of NIRS ............................................................................... 436References .............................................................................................. 437
23 Magnetic Resonance ImagingWolfgang R. Nitz ..................................................................................... 43923.1 History of MRI ............................................................................... 43923.2 MRI – System Components ............................................................. 441
Contents XXV
23.3 MRI – Basic Principles and Applications .......................................... 44623.4 MRI – Safety-Relevant Aspects ....................................................... 45323.5 MRI – Pictures of the Future .......................................................... 456References .............................................................................................. 458
24 Magnetic Particle ImagingJörn Borgert, Bernhard Gleich, Thorsten M. Buzug..................................... 46124.1 Introduction ................................................................................. 46124.2 A Brief History of Magnetic Particle Imaging.................................... 46224.3 How Magnetic Particle Imaging Works ............................................ 46324.4 From Data to Images – Reconstruction ........................................... 46824.5 Beyond General Purpose Systems – Special Geometry ..................... 47024.6 Putting MPI to Use – Applications .................................................. 472References .............................................................................................. 474
25 MR-Guided Interventions and SurgeryAndreas Melzer, Erwin Immel, Rachel Toomey,
Fabiola Fernandez-Gutierrez.................................................................... 47725.1 MRI Basics ..................................................................................... 47825.2 MRI Image Guidance for Interventions and Surgery in Comparison
with CT and Ultrasound ................................................................. 47925.3 MR Systems Design and Setup for Interventions and Surgery ........... 47925.4 Instruments for Interventional and Intraoperative MRI ................... 48225.5 MR-Applicable Endoscopic Instrument Systems ............................... 48225.6 Instrument Representation and Tracking in MRI .............................. 48325.7 MR-Guided Robotics and Navigation .............................................. 48525.8 Hybrid Multimodal Imaging for MR-Guided Diagnosis and Therapy .. 49125.9 Therapeutic MR-Guided Imaging .................................................... 49325.10 MR-Guided Delivery of Implants .................................................... 49425.11 Conclusions ................................................................................... 498References .............................................................................................. 498
26 Devices and Materials in MRIGregor Schaefers, Andreas Melzer ............................................................. 50326.1 MR Safety ...................................................................................... 50426.2 Interactions in the MR Environment ............................................... 50426.3 Examples of MR Artifacts Caused by Medical Devices ........................ 51026.4 Evaluation of MRI Artifacts of Implants ........................................... 51226.5 MR Safety Labeling ........................................................................ 51426.6 Interpretation of MR Labeling ........................................................ 51726.7 Discussion ..................................................................................... 518References .............................................................................................. 519
XXVI Contents
Part D Therapeutic Devices
27 Long-Term Ventilators for Intensive TherapyThomas Peyn ........................................................................................... 52527.1 Tasks of the Ventilator ................................................................... 52527.2 Function and Components of a Long-Term Ventilator ...................... 52627.3 Technical Implementation ............................................................ 52927.4 Controlling the Ventilator .............................................................. 53027.5 Ventilation Procedures .................................................................. 53127.6 Ventilation Extras and Special Functions......................................... 54027.7 Patient Monitoring and Alarm Limits .............................................. 54327.8 Weaning Strategy and SmartCare/PS ............................................... 543
28 Defibrillators and ICD SystemsRüdiger Kramme...................................................................................... 54528.1 Defibrillator Technology ................................................................. 54628.2 Therapeutic Intervention ............................................................... 54928.3 Methodological Notes .................................................................... 55028.4 Complications ............................................................................... 55128.5 Technical Safety Aspects................................................................. 55128.6 Implantable Cardioverter-Defibrillators .......................................... 551References .............................................................................................. 556
29 Laser SystemsFrank Zgoda ............................................................................................ 55729.1 History of the Laser ....................................................................... 55829.2 Physics and Technology ................................................................. 55829.3 Application Methods ..................................................................... 56429.4 Biophysical Effects on Tissue .......................................................... 56429.5 Laser Types in Medicine ................................................................. 56729.6 Fields of Use ................................................................................. 57129.7 Safety Aspects ............................................................................... 57429.8 Future Prospects ............................................................................ 577References .............................................................................................. 577
30 Inhalational Anesthesia DevicesErich Siegel.............................................................................................. 57930.1 Anesthesia Devices in General Anesthesia ....................................... 57930.2 Functional Principle, Medical Aspects ............................................. 58030.3 Functional Principle of the Main Components ................................. 58230.4 Safe Operation Prerequisites .......................................................... 594Further Reading ...................................................................................... 595
31 Extracorporeal Blood Purification SystemsJörg Vienken ............................................................................................ 59731.1 Historical Perspective .................................................................... 59831.2 Blood Purification for the Therapy of Renal Failure ......................... 600
Contents XXVII
31.3 Dialysis Machines and Additional Equipment: Use and Conditions ... 61131.4 Blood Purification in Liver Replacement Therapy............................. 614References .............................................................................................. 617
32 Heart–Lung MachinesUlrich Böckler, Andreas Hahn ................................................................... 62132.1 Historical Development of Extracorporeal Circulation....................... 62132.2 Extracorporeal Circulation .............................................................. 62332.3 Structure and Function of the Heart–Lung Machine ........................ 62332.4 Components of the Heart–Lung Machine ........................................ 62732.5 Extracorporeal Circulation .............................................................. 62932.6 Differentiation of Heart–Lung Machines ......................................... 63532.7 Aspects of Technical Safety ............................................................. 63632.8 Prospects for Further Development ................................................. 637References .............................................................................................. 638
33 Application of Shock Waves and Pressure Pulses in MedicineFriedrich Ueberle...................................................................................... 64133.1 Introduction – Historical Development ........................................... 64233.2 Definitions of Physical Terms: Acoustics – Sound Waves –
Pressure Pulses – Shock Waves ....................................................... 64333.3 The Acoustic Field of a Lithotripter –
Basics of Measurement Technology ................................................ 64933.4 Generation of Pressure Pulses for Extracorporeal Lithotripsy (ESWL)
and Extracorporeal Shock Wave Therapy (ESWT) ............................... 66033.5 Extracorporeal Lithotripsy (ESWL)
and Extracorporeal Shock Wave Therapy (ESWT) in Practice .............. 66433.6 The Patient ................................................................................... 66733.7 Assessment of the Clinical Efficiency of Lithotripters ....................... 66833.8 Associations and Societies for Lithotripsy and Pressure Pulse
Therapy ........................................................................................ 670References .............................................................................................. 671
34 High-Frequency SurgeryBernhard Hug, Reiner Haag ..................................................................... 67734.1 Development of High-Frequency Surgery ........................................ 67834.2 Physical and Technical Principles ................................................... 68134.3 Technology and Techniques ........................................................... 68434.4 Types of Current and Their Application ........................................... 68739.5 Methodical Instructions for Application and Safety ......................... 69734.6 Outlook ......................................................................................... 700References .............................................................................................. 701
35 Medical Radiation TherapyPeter H. Cossmann ................................................................................... 70335.1 X-Radiation .................................................................................. 70435.2 Historical Development of Radiation Therapy .................................. 704
XXVIII Contents
35.3 Physical and Technical Principles of Radiation Physics..................... 70535.4 Forms of Therapy ........................................................................... 70835.5 Equipment Technology for the Generation of Radiation .................. 71035.6 Special Techniques and Newer Developments in Teletherapy ........... 716References .............................................................................................. 721
36 Mechanical Circulatory Support SystemsRoland Hetzer, Ewald Hennig ................................................................... 72336.1 Introduction – History ................................................................... 72436.2 Indications for Application of MCSS................................................. 72536.3 Classification of MCSS ..................................................................... 72736.4 Today’s Systems ............................................................................ 72836.5 Complications ............................................................................... 73936.6 Technical Follow-Up and Care ........................................................ 74236.7 Psychosomatic Syndromes and Quality of Life During Treatment
with MCS ....................................................................................... 74236.8 Overview and Outlook ................................................................... 744References .............................................................................................. 747
37 Neural Interfaces for Implanted StimulatorsXiao Liu, Andreas Demosthenous, Nick Donaldson ..................................... 74937.1 Stimulating Electrodes ................................................................... 75137.2 Implantable Cable Management .................................................... 75337.3 Design of Stimulator Output Stage .................................................. 75637.4 Conclusions ................................................................................... 763References .............................................................................................. 764
38 Cardiac Pacemaker SystemsArmin Bolz .............................................................................................. 76738.1 Structure of a Pacemaker System .................................................... 76838.2 The Functionality of a Cardiac Pacemaker ....................................... 77138.3 Stimulation Modes ........................................................................ 774References .............................................................................................. 782
39 Introduction to NeuroprostheticsKlaus-Peter Hoffmann, Silvestro Micera .................................................... 78539.1 Neuroprostheses ........................................................................... 78539.2 Application of Neural Prostheses .................................................... 78739.3 Specific Technological Features ...................................................... 78839.4 Biological–Technical Interface ....................................................... 79039.5 Future Developments .................................................................... 798References .............................................................................................. 799
Contents XXIX
40 Implantable MicrosystemsPrashant Tathireddy, Florian Solzbacher, Robert Hitchcock,
Klaus-Peter Hoffmann ............................................................................. 80140.1 Market, Applications, and Common Requirements .......................... 80140.2 Sensors ......................................................................................... 80540.3 In vitro and in vivo Testing ............................................................ 814References .............................................................................................. 816
41 Visual ProsthesesEduardo Fernandez, Klaus-Peter Hoffmann .............................................. 82141.1 The Case for Artificial Vision ........................................................... 82241.2 Visual Pathways: From Real Vision to Visual Neuroprostheses .......... 82241.3 Current Approaches to Visual Prostheses ......................................... 82441.4 Engineering Visual Neuroprostheses ............................................... 82741.5 Safe and Effective Stimulation of Visual Pathways
Through Multiple Microelectrodes .................................................. 82941.6 Selection of Suitable Subjects for a Visual Prosthesis ....................... 83041.7 Challenges and Future Perspectives ................................................ 831References .............................................................................................. 832
42 Rehabilitation and Therapeutic RoboticsLoredana Zollo, Dino Accoto, Silvia Sterzi, Eugenio Guglielmelli ................. 83542.1 Background .................................................................................. 83542.2 Human-Centered Approach to Rehabilitation Robot Design ............. 83742.3 Robot-Based Measure of Patient’s Performance.............................. 84442.4 Conclusions and Further Readings .................................................. 850References .............................................................................................. 851
43 Cardiac Devices and TestingMichael Bateman, Stephen A. Howard, Christopher Rolfes,
Timothy G. Laske, Paul A. Iaizzo ............................................................... 85543.1 Background .................................................................................. 85643.2 Selected Landmark Events in Cardiac Devices and Surgery ............... 85643.3 Market Released Cardiac Devices .................................................... 85743.4 Device Development ...................................................................... 85743.5 The Anatomy of a Device ................................................................ 86743.6 Emerging Cardiac Device Technology .............................................. 87143.7 Conclusions ................................................................................... 874References .............................................................................................. 874
44 Functional Electrical Stimulation in Rehabilitationand NeurorehabilitationKei Masani, Milos R. Popovic .................................................................... 87744.1 The Basis of Electrical Stimulation .................................................. 87844.2 Neuroprosthetic Use of FES ............................................................. 883
XXX Contents
44.3 FES Therapy ................................................................................... 88944.4 Other Uses of Electrical Stimulation ................................................ 89044.5 Concluding Remarks ...................................................................... 890References .............................................................................................. 890
45 Treatment Planning and Patient TreatmentGolam Abu Zakaria, Wilhelm Schütte, Stephan Garbe ................................ 89745.1 Principles of Radiotherapy and Treatment Planning ........................ 89845.2 Imaging in Treatment Planning...................................................... 90145.3 Basic Techniques in External Beam Therapy .................................... 90245.4 Target Volumes and Organ at Risk .................................................. 90945.5 Modern Treatment Planning Systems .............................................. 91045.6 Simulation of the Patient and the First Treatment........................... 91545.7 Quality Control in Radiation Therapy .............................................. 917References .............................................................................................. 919
Part E Monitoring
46 Recording and Processing of BiosignalsKlaus-Peter Hoffmann, Florian Solzbacher................................................ 92346.1 Measuring in Medicine .................................................................. 92346.2 Registration of Biological Signals ................................................... 93446.3 Measurement and Signal Analysis from a Metrological Point of View 94046.4 Test Planning and Clinical Studies .................................................. 944Further Reading ...................................................................................... 945
47 Monitoring SystemsUllrich Hieronymi, Rüdiger Kramme .......................................................... 94747.1 Fields of Use for Patient Monitoring Systems ................................... 94847.2 Types of Monitors .......................................................................... 94947.3 Monitor Screen Content ................................................................. 95147.4 Handling ...................................................................................... 95247.5 Alarms and Events ......................................................................... 95247.6 Trend Display ................................................................................ 95247.7 Automatic Calculations .................................................................. 95347.8 Advanced System Properties .......................................................... 95347.9 Central Monitoring and Documentation .......................................... 953Further Reading ...................................................................................... 954
48 Cardiovascular MonitoringUllrich Hieronymi, Rüdiger Kramme .......................................................... 95548.1 Monitoring the Cardiac Function .................................................... 95548.2 Monitoring the Circulatory Function (Hemodynamic Monitoring) ...... 957References .............................................................................................. 969
Contents XXXI
49 Respiratory Monitoring and Pulse OximetryUllrich Hieronymi, Rüdiger Kramme, Harald Kronberg ............................... 97149.1 Respiratory Mechanics ................................................................... 97149.2 Gas Exchange ................................................................................ 973References .............................................................................................. 985
50 Temperature MonitoringRüdiger Kramme, Ullrich Hieronymi .......................................................... 98750.1 Hyperthermia and Hypothermia ..................................................... 98750.2 Measuring Sites for Temperature Measurement ............................... 98750.3 Temperature Sensors and Probes.................................................... 98750.4 Methodological Notes .................................................................... 989Further Reading ...................................................................................... 990
51 Cerebral MonitoringBarbara Schultz, Arthur Schultz, Harald Kronberg ..................................... 99151.1 EEG Monitoring ............................................................................. 99151.2 Intracranial Pressure ..................................................................... 995References .............................................................................................. 1000
52 Brain Computer InterfaceGünter Edlinger, Cristiano Rizzo, Christoph Guger...................................... 100352.1 Introduction to BCI ........................................................................ 100352.2 Measuring Brain Activity ................................................................ 100452.3 BCI System Structure ...................................................................... 100552.4 Conclusions ................................................................................... 1014References .............................................................................................. 1015
53 Fetal MonitoringBirgit Wacker, Martin Maier...................................................................... 101953.1 Cardiotocography (CTG) .................................................................. 101953.2 Obstetric Monitoring Systems ......................................................... 1022Further Reading ...................................................................................... 1030
54 Neonatal MonitoringRoland Hentschel..................................................................................... 103154.1 Electrocardiogram ......................................................................... 103254.2 Impedance Pneumography ............................................................ 103354.3 Combined Cardiorespiratory Analysis .............................................. 103454.4 Pulse Oximetry .............................................................................. 103554.5 Transcutaneous Measurement of the Partial Pressure ...................... 103754.6 Measurement of the PtcCO2 (Transcapnode) .................................... 103854.7 Measurement of the PtcO2 (Transoxode) ......................................... 103854.8 Monitoring the Oxygenation – Which Method? ............................... 103954.9 Setting Alert Limits and Limit Values............................................... 1040References .............................................................................................. 1041
XXXII Contents
55 Intraoperative NeuromonitoringWerner Kneist, Daniel W. Kauff ................................................................. 104355.1 General Principles ......................................................................... 104355.2 Neuromonitoring Signals ............................................................... 104655.3 Scope of Application ...................................................................... 104855.4 Quality Management ..................................................................... 105655.5 Guidelines and Legal Aspects ......................................................... 1056Further Reading ...................................................................................... 1057
56 Ionic Neural SensingIasonas F. Triantis, Anna Radomska-Botelho Moniz, Kostis Michelakis,
Sanjiv Sharma, Jakub Trzebinski, Belinda Garner, Amir Eftekhar ................ 105956.1 Central and Peripheral Nervous System Monitoring ......................... 106056.2 Chemistry of Neural Activity ........................................................... 106456.3 Chemical Neural Sensing Technology and Challenges....................... 106556.4 Conclusion .................................................................................... 1069References .............................................................................................. 1070
Part F Medical Information Processing and Communication
57 Fusing Medical Engineering and Information Technology –Structure, Integration and Process OptimizationHajo Tanck, Michael Heinlein ................................................................... 107557.1 Standards of Interfaces .................................................................. 107657.2 Data Structure ............................................................................... 107757.3 Integrating the Healthcare Enterprise ............................................. 107857.4 Integration of Medical Devices ....................................................... 107857.5 Sample Integration – From Findings to Medical Documentation ...... 108257.6 Résumé ........................................................................................ 1082Further Reading ...................................................................................... 1083
58 Communicating Medical Systems and NetworksArmin Gärtner ......................................................................................... 108558.1 Medical Networks .......................................................................... 108558.2 Requirements for Medical Networks ............................................... 108658.3 Interconnected Medical Networks .................................................. 108758.4 Risk Management, DIN EN ISO 14971 ................................................ 108858.5 Shared Networks ........................................................................... 108958.6 Security Aspects of Medical Networks from a Regulatory Viewpoint .. 109258.7 Future Standard IEC 80001-1 .......................................................... 1093References .............................................................................................. 1093
59 Hospital Information SystemsPeter Haas, Klaus A. Kuhn ........................................................................ 109559.1 Background .................................................................................. 109559.2 Necessity, Objectives, and Benefits of Comprehensive HIS................ 1096
Contents XXXIII
59.3 Dimensions of IT Support ............................................................... 109859.4 Case Study .................................................................................... 109959.5 Architecture and Components of HIS ............................................... 110359.6 Current Trends and Prospects ......................................................... 110859.7 Selection and Implementation of HIS ............................................. 111059.8 Conclusion .................................................................................... 1117References .............................................................................................. 1118
60 Telemedicine in GermanyRüdiger Klar, Ernst Pelikan....................................................................... 111960.1 The Peculiar Features of German Telemedicine ............................... 112060.2 Consequences of the Peculiarities of the German System
for Telemedicine ........................................................................... 1125References .............................................................................................. 1126
61 Telemedicine Using Active ImplantsKlaus P. Koch, Oliver Scholz ...................................................................... 112961.1 Telemedicine in the Operating Theater ........................................... 112961.2 Telemedicine in Domestic Care ....................................................... 113061.3 Implant Telemetry ......................................................................... 113161.4 Inclusion of Active Medical Implants in Telemedicine Systems ......... 1136References .............................................................................................. 1136
62 Fundamentals of Medical Image ProcessingThomas M. Deserno.................................................................................. 113962.1 Background .................................................................................. 113962.2 Remarks on the Terminology.......................................................... 114162.3 Image Enhancement ..................................................................... 114262.4 Feature Extraction ......................................................................... 114762.5 Segmentation ............................................................................... 114862.6 Classification ................................................................................. 115462.7 Quantitative Measurements ........................................................... 115762.8 Interpretation ............................................................................... 115862.9 Image Data Visualization ............................................................... 115862.10 Image Management ...................................................................... 116162.11 Conclusion and Outlook ................................................................. 1163References .............................................................................................. 1165
63 Virtual Reality in MedicineWolfgang Müller-Wittig ........................................................................... 116763.1 Virtual Reality ............................................................................... 116863.2 Medical Applications ..................................................................... 116863.3 VR-Based Medical Simulation ........................................................ 117463.4 Model Generation – Virtual Anatomy ............................................. 117563.5 Manipulations – Surgical Interventions .......................................... 117863.6 Outlook ......................................................................................... 1182References .............................................................................................. 1184
XXXIV Contents
64 Computer-Supported Teaching and Learning Systems in MedicineMartin Haag, Martin R. Fischer................................................................. 118764.1 Historical Development.................................................................. 118764.2 Moves Towards the Reform of Medical Studies ................................ 118964.3 Developing Learning and Teaching Systems .................................... 118964.4 Learning Environments .................................................................. 119364.5 Application Scenarios for Learning and Teaching Systems ................ 119564.6 Status of and Outlook for e-Learning in Medicine ........................... 1195References .............................................................................................. 1197
65 PACS and RISChristian Zapf, Andreas Bermann, Dirk Sunderbrink .................................. 119965.1 Radiological Workflow ................................................................... 120065.2 Integrating PACS/RIS into the Hospital Environment ........................ 120565.3 State-of-the-Art IT Infrastructure .................................................. 120665.4 Summary ...................................................................................... 1208References .............................................................................................. 1208
66 3-D Postprocessing in Virtual EndoscopyGeorg-Friedemann Rust ........................................................................... 120966.1 What Is Virtual Reality? .................................................................. 121066.2 Why Virtual Reality? ....................................................................... 121066.3 Advantages of 3-D Visualization ..................................................... 121066.4 Conclusions ................................................................................... 1216References .............................................................................................. 1216
67 e-Health – Ambient Assisted Living and Personal Health SystemsNatasha Avila, Christina Sampogna.......................................................... 121767.1 Background .................................................................................. 121867.2 AAL and PHS Approaches ................................................................ 122167.3 Benefits and Challenges Ahead ...................................................... 123467.4 Conclusion .................................................................................... 1241References .............................................................................................. 1243
68 Electrical Stimulation of the Nervous SystemStanisa Raspopovic, Marco Capogrosso, Silvestro Micera ............................ 124768.1 Background .................................................................................. 124768.2 Biophysics Models of Neuronal Response to External Fields ............. 124868.3 Finite Element (FE) Models ............................................................. 125268.4 Conclusion .................................................................................... 1256References .............................................................................................. 1256
Contents XXXV
Part G Equipment and Tools
69 Operating Tables – the Surgeon’s WorkplaceBernhard Kulik ........................................................................................ 126169.1 The History of the Operating Table .................................................. 126269.2 The OR Table System ...................................................................... 126369.3 Technology of Operating Room Table Systems ................................. 126469.4 Safe Patient Positioning................................................................. 126869.5 Preparation: Care, Maintenance, and Hygiene ................................ 1271Further Reading ...................................................................................... 1272
70 Medical RoboticsHarald Fischer, Udo Voges ........................................................................ 127370.1 Fundamentals ............................................................................... 127370.2 Development of Medical Robots ..................................................... 127470.3 Overview of Systems ...................................................................... 127570.4 Medical Applications ..................................................................... 128070.5 Technical Aspects .......................................................................... 128170.6 Outlook ......................................................................................... 1282References .............................................................................................. 1283
71 IncubatorsGuenther Braun, Roland Hentschel ........................................................... 128571.1 Historical Background .................................................................... 128571.2 Construction and Function of an Incubator ..................................... 128671.3 Incubator Models .......................................................................... 128771.4 Risks of Incubator Therapy ............................................................. 128971.5 Hygiene ........................................................................................ 128971.6 Unsolved Problems ........................................................................ 1290References .............................................................................................. 1290
72 Surgical ScissorsReiner Haag, Wilfried Storz ...................................................................... 129172.1 The History of Scissors .................................................................... 129272.2 The Function and Design of Scissors ............................................... 129372.3 Materials ...................................................................................... 129472.4 Manufacture of Surgical Scissors ..................................................... 129472.5 Diversification Overview ................................................................ 129772.6 Handling and Care ........................................................................ 131072.7 Inspection, Testing, and Care ......................................................... 131472.8 Packaging ..................................................................................... 131472.9 Current Terminology ...................................................................... 131572.10 Steam Sterilization with Saturated Steam ....................................... 131572.11 Quality Characteristics.................................................................... 131672.12 Future Developments .................................................................... 131772.13 Bipolar Scissors ............................................................................. 1318References .............................................................................................. 1319
XXXVI Contents
73 Intelligent Textiles and TrendsChristian Rotsch, Sibylle Hanus, Danny Schwabe, Heike Oschatz,
Andreas Neudeck, Uwe Möhring ............................................................... 132173.1 Textile Manufacturing Technologies and Applications ...................... 132173.2 Sensory Applications of Textiles ...................................................... 132673.3 Active Textiles – Therapeutical Applications .................................... 133073.4 Passive Medical Textiles for Therapy ............................................... 1333References .............................................................................................. 1335
74 Electronics in MedicinePaulo M. Mendes, Celso P. Figueiredo, Mariana Fernandes, Óscar S. Gama . 133774.1 Basics ........................................................................................... 133874.2 Electronic Sensing ......................................................................... 134174.3 Electronics for Wireless Health Monitoring ...................................... 134474.4 Power Supply ................................................................................ 134874.5 Wearable Medical Electronics ......................................................... 135374.6 Electronics in Medicine at Work...................................................... 1358References .............................................................................................. 1373
Appendix.................................................................................................... 1377Acknowledgements ................................................................................... 1391About the Authors ..................................................................................... 1393Detailed Contents ...................................................................................... 1415Subject Index ............................................................................................. 1455
XXXVII
List of Abbreviations
μTAS micro total analytical system1-D one-dimensional2-D two-dimensional3-D three-dimensional3-D CSI three-dimensional chemical shift imaging4-D four-dimensional
A
A-mode amplitude modeA/D analogue/digitalAAA abdominal aortic aneurysmAAL ambient assisted livingAAMI Association for the Advancement of
Medical InstrumentationABI auditory brainstem implantABLB alternate binaural loudness balanceABR auditory brainstem responsesAC air conductionAC alternating currentACC American College of CardiologyACD absolute claudication distanceACT activated clotting timeADC analog-to-digital converterADHD attention-deficit/hyperactivity disorderADL advanced distributed learningADSL asymmetric digital subscriber lineADT admission, discharge, and transferAEC automatic exposure controlAED automated external defibrillatorAEP auditory evoked potentialAEP acoustic evoked potentialAGC automatic gain controlAGC/i input-controlled automatic gain controlAGC/o output-controlled automatic gain controlAGIT Arbeitsgemeinschaft InformationstechnikAHA American Heart AssociationAI artificial intelligenceAIx augmentation indexACF autocorrelation functionALL acute lymphatic leukemiaALS amyotrophic lateral sclerosisAMFR amplitude modulation following responseAMI alternate mark inversionAMI auditory midbrain implantAMIGO advanced multimodality image-guided
operating roomAML acute myeloic leukaemiaANSD auditory neuropathy spectrum disorderAP anaesthetic proofAPD auditory processing disorder
APOD adaptive probe off detectionAPm mean arterial pressureAR augmented realityAR automated refractometerARM Aspen return monitorART algebraic reconstruction techniqueASB assisted spontaneous breathingASD atrial septal defectASHA American Speech and Hearing
AssociationASICS application-specific integrated circuitASL arterial spin labelingASSR auditory steady-state responseASTM American Society for Testing and
MaterialsAT adaptive tripoleATC automatic tube compensationATMP advanced therapy medicinal productATP antitachycardic pacingATP adenosine triphosphateATPD ambient temperature and pressure, dryATPS ambient temperature and pressure,
saturatedATS American Thoracic SocietyAV atrioventricularAVC automatic volume controlAWIGS advanced workplace for image guided
surgery
B
B-mode brightness modeB2B business-to-businessBAHA bone-anchored hearing aidBANG bis acrylamide nitrogen gelatinBAR billing and accounting requestBART breathing-adapted radiotherapyBC bone conductionBCI brain–computer interfaceBCM body composition monitorBER bit error ratioBERA brainstem electric response audiometryBERA brainstem evoked response audiometryBF body floatingBGA blood gas analysisBGO bismuth germanateBILD binaural intelligibility level differenceBIS bispectral indexbit binary digitBL blended learningBMLD binaural masking level difference
XXXVIII List of Abbreviations
BOLD blood oxygenation-dependent imagingBPEG British Pacing and Electrophysiology
GroupBPH benign prostate tissueBPS battery-supported power supplyBSE bovine spongiform encephalopathyBSN body sensor networkBTB bridge to bridgeBTD bridge to decisionBTE behind the earBTPS body temperature and pressure, saturatedBTR bridge to recoveryBTT bridge a patient to transplantationBVAD biventricular assist deviceBfArM Bundesinstitut für Arzneimittel und
MedizinprodukteBipol-TUR bipolar transurethral resection
C
CABG coronary artery bypass graftingCAD computer-aided diagnosisCAD coronary artery diseaseCAL computer-assisted learningCAM computer-aided manufactureCAP contention access periodCAPD central auditory processing disorderCAS compressed analog stimulation strategyCAS computer-aided surgeryCAT computerized axial tomographyCBCT cone-beam computed tomographyCBF cerebral blood flowCBI computer-based instructionCBIR content-based image retrievalCBT computer-based trainingCBV cerebral blood volumeCCC China compulsory certificateCCD charge-coupled deviceCCITT Comité Consultatif International
Téléphonique et TélégraphiqueCCR continuity of care recordCCU camera control unitCCU coronary care unitCCU critical care unitCD compact discCD-ROM compact disc read-only memoryCDA clinical document architectureCDC Center for Disease ControlCDM central display and control moduleCE contractile elementCEN Comité Européen de NormalisationCENELEC European Committee for Electrotechnical
StandardizationCERA cortical electric response audiometryCF cardiac floatingCFP contention-free period
CGM continuous glucose monitoringCGMS continuous glucose monitoring systemCGS centimeter-gram-secondCI cochlear implantCI confidence intervalCIC completely in the canalCIM ceramic injection moldingcIONM continuous intraoperative
neuromonitoringCIRS computer integrated radiology systemCJD Creutzfeldt–Jakob diseaseCL comfortable stimulation levelCLT color lookup tableCMCT central motor conduction timeCML chronic myeloic leukemiaCMOS complementary
metal–oxide–semiconductorCMRR common mode rejection ratioCNAP continuous noninvasive arterial pressureCNC computer numerically controlledCNCA Certification and Accreditation
Administration of the Peoples Republicof China
CNS central nervous systemCNT carbon nanotubeCNV choroidal neovascularizationsCNV contingent negative variationCO cardiac outputCPA continuous positive airwayCPAP continuous positive airway pressureCPK creatine phosphokineaseCPOE computerized physician order entryCPP cerebral perfusion pressureCPU central processing unitCQC China Quality Certification CentreCQM contact quality monitorCR computed radiographyCROS contralateral routing of signalsCRT cardiac resynchronization therapyCRT cathode-ray tubeCSCL computer-supported
cooperative/collaborative learningCSCN customer support clinical networkCSCW computer-supported cooperative workCSF cerebrospinal fluidCSMA-CA carrier sense multiple access with
collision avoidanceCSSD central sterilization supply departmentCT computer tomograph(y)CTA CT-angiographyCTG cardiotocographyCTI computed tomography imagingCTV clinical target volumeCUNY City University of New YorkCVC central venous catheterCVD cardiovascular disease
List of Abbreviations XXXIX
CVD congenital vascular disorderCVP central venous pressureCW continuous waveCWRUVA Case Western Reserve
University/Department of VeteransAffairs
D
D2D doctor-to-doctorDAC digital-to-analog converterDART dynamic adaptive radiotherapyDAS data-acquisition systemDAS detector angular subtenseDBS deep brain stimulationDC direct currentDCT dynamic contour tonometryDECT digital enhanced cordless
telecommunicationDFM design for manufactureDFT defibrillation thresholdDFT detail financial transactionDGSL Deutsche Gesellschaft für
StosswellenlithotripsieDGSM German Sleep SocietyDHZB Deutsches Herzzentrum BerlinDICOM digital imaging and communications in
medicineDIHK Deutscher Industrie- und
HandelskammertagDIMDI Deutsches Institut für Medizinische
Dokumentation und InformationDIT differential infrared thermographyDMD Duchenne muscular dystrophyDNA deoxyribonucleic acidDNEP descending neurogenic evoked potentialDOF degree of freedomDPF differential path lengthDPOAE distortion product otoacoustic emissionDQE dose quantum efficiencyDR direct radiographyDR dual rateDRC dynamic range compressionDRG diagnosis related groupDRL driven right legDRR digitally reconstructed radiographDRR dynamic range reductionDSA digital subtraction angiographyDSL desired speech levelDSO distribution system operatorDSP digital signal processorDT destination therapyDTI diffusion tensor imagingDTL Dawson–Trick–LitzkowDVD digital versatile discDVH dose volume histogram
DWI diffusion-weighted imagingDoD Department of DefenseDoF degree of freedom
E
E-ABR evoked auditory brainstem responsee-HC electronic health cardEAEP early auditory evoked potentialEAS electric and acoustic stimulationEBCT electron-beam computed tomographyEBUS endobronchial ultrasonographyECC enhanced cornea compensationECC extracorporeal circulationECG electrocardiogramECG electrocardiograph(y)ECMO extracorporeal circulatory supportECW extracellular waterECoG electrocortical gridECoG electrocorticographyED energy flux densityEDG electrodermographyEDP electronic data processingEDTA ethylenediaminetetraacetic acidEEG electroencephalogramEEG electroencephalograph(y)eFA electronic case recordEFOV extended field of viewEFT electrical fast transientEG electrogramEGFET extended gate field effect transistorEGG electrogastrographyEHG electrohysterographyEHR electronic health recordEHT electrohydrothermosationEIRP effective isotropically radiated powerEIS electrochemical impedance spectroscopyEL electroluminescentEM electromagneticEMC electromagnetic compatibilityEMEA European Medicine AgencyEMG electromyogramEMG electromyograph(y)EMI Electric and Musical Industries Ltd.EMI electromagnetic interferenceEMS electrical muscle stimulationEMSE electromagnetic sourceENG electronystagmographyENG electroneurogramENG electroneurographyENT ear, nose, throatEO electroopticEO ethylene oxideEOAE evoked otoacoustic emissionEOG electrooculogramEOG electrooculography
XL List of Abbreviations
EP electropolishedEP evoked potentialEPR electronic patient recordEPSP excitatory postsynaptic potentialER enhanced realityERA electric response audiometryERB equivalent rectangular bandwidthERD event-related desynchronizationERG electroretinographyERG electroretinogramERP early receptor potentialERP event related potentialERS European Respiratory SocietyERS event-related synchronizationERV expiratory reserve volumeESC European Society of CardiologyESD electrostatic dischargeESWL extracorporeal shock wave lithotripsyESWT extracorporeal shock wave treatmentESWT extracorporeal shock wave therapyETL echo train lengthETO ethylene oxideETSI European Telecommunications Standards
InstituteEUG ectopic pregnancy (Extrauteringravidität)EUS endosonographicEUTox European Uremic Toxin Working GroupEVC expiration volume capacity
F
FA flip angleFAEP brainstem auditory evoked potentials
(frühe akustisch evozierte Potentiale)FBP filtered back-projectionFCC US Federal Communications
CommissionFDA US Food and Drug AdministrationFDI Fédération Dentaire InternationaleFDL flashlamp pumped dye laserFDRC full dynamic range compressionFEL free-electron laserFEM finite element methodFES functional electrical stimulationFET FES therapyFFE fast field echoFFP field free pointffs form/fill/sealFFT fast Fourier transformationFHN Fitzhugh–NagumoFINE flat interface nerve electrodeFIR far-infraredFIV1 forced expiratory volume in 1 sFLAIR fluid-attenuated inversion recoveryFLASH fast low-angle shotFMD fibromuscular dysplasia
FMEA failure modes and effects analysisfMRI functional magnetic resonance imagingFMT floating mass transducerFO formaldehydeFOV field of viewFP Framework ProgrammeFRC functional residual capacityFSE fast spin echoFSK frequency shift keyingFSM Frederick S. MikelbergFSP fine structure processingFT Fourier transformationFTIR Fourier transform infraredFVC forced vital capacityFWHM full width at half maximumFoV field of view
G
GA genetic algorithmGCP good clinical practiceGEDV global end-diastolic volumeGEF global ejection fractionGIF graphics interchange formatGM gray matterGMDS Society for Medical Informatics,
Biometry and EpidemiologyGMG Law on the Modernization of HealthcareGOx glucose oxidaseGPU graphics processing unitGRAPPA generalized autocalibrating partially
parallel acquisitionGRE gradient echoGS general supplyGSDOM German Society of Dental, Oral and
Craniomandibular SciencesGSM Global System for Mobile
CommunicationsGSR galvanic skin responseGTV gross tumor volumeGTWM Georgia Tech Wearable MotherboardGUI graphical user interface
H
hcg human chorionic gonadotropicHCV hepatitis C virusHD hemodialysisHDD hard-disc driveHDF hemodiafiltrationHDR high-dose rateHEMO hemodialysisHF hemofiltrationHF high frequencyHFCS high-frequency current-switchingHFITT HF-induced interstitial tumor therapy
List of Abbreviations XLI
HH Hodgkin and HuxleyHI hypopnea indexHINT hearing in noise testHIS hospital information systemHL hearing levelHL hearing lossHL7 Health Level 7HLD high level disinfectionHLM heart–lung machineHMD head-mounted displayHME heat and moisture exchangerHMEF heat and moisture exchange filterHPC health professional cardHR heart rateHRT Heidelberg Retina TomographHTX heart transplantHU Hounsfield unitHV Vickers hardnessHb hemoglobinHbt hemoglobin concentrationHpD hematoporphyrin derivative
I
IC inspiratory capacityIC integrated circuitICD implantable cardioverter-defibrillatorICD International Classification of DiseasesICD implantable cardioverter–defibrillatorICD initial claudication distanceICG impedance cardiogramICG indocyanine greenICP intracranial pressureICSD International Classification of Sleep
DisordersICSPE International Commission for the
Standardization of ErgometryApplication
ICT information and communicationtechnology
ICT information and computer technologyICU intensive care unitICW intracellular waterID identification numberIDE investigational device exemptionIDEFIX identification of dental fixturesIEC International Electrotechnical
CommissionIEGM intracardial electrogramIFOV instantaneous field of viewIG insertion gainIGRT image guided radiotherapyIGV intra-thoracic gas volumeIHC inner hair cellIHE integrating healthcare enterprises
IHS inspiratory help systemiIONM intermittent intraoperative
neuromonitoringILR implantable loop recorderILV independent lung ventilationIMAT intensity-modulated arc therapyIMRT intensity-modulated radiotherapyINA instrumentation amplifierIOERT intraoperative electron radiation therapyIOL intraocular lensIOM Institute of MedicineIONM intraoperative neuromonitoringIOP intraocular pressureIP intellectual propertyIPPV intermittent positive pressure ventilationIPSP inhibitory postsynaptic potentialIQ installation qualificationIR infraredIRFI infrared functional imagingIRMA image retrieval in medical applicationsIROG infrared oculographyIRV inspiratory reserve volumeISDN integrated services digital networkISE ion-selective electrodeISF interstitial fluidISFET ion-sensitive field effect transistorISM industrial, scientific, and medicalISO International Standardization
OrganizationIT information technologyITBV intrathoracic blood volumeITGV intra-thoracic gas volumeITS initial transmission slotITU International Telecommunication UnionIVC inspiration vital capacity
J
jnd just noticeable difference
K
KIT Karlsruhe Institute of TechnologyKV health insurance (Krankenversicherung)
L
LAN local area networkLAP left atrial pressureLASER light amplification by stimulated
emission of radiationLCA Leber’s amaurosisLCD liquid-crystal displayLDA linear discriminant analyzerLDH lactate dehydrogenase
XLII List of Abbreviations
LDR low-dose rateLED light-emitting diodeLF low frequencyLFP local field potentialLGN lateral geniculate nucleusLI laser iridotomyLITT laser-induced thermotherapyLLLT low-level laser therapyLLT laser lithotripsyLMS learning management systemLOINC logical observation identifiers names and
codesLPRT low-power, real-time protocolLSHD light spot hydrophoneLTP low-temperature plasma sterilizationLUT look-up tableLVAD left ventricular assist deviceLWIR long-wavelength infraredLiDCO lithium ion dilution
M
M-mode motion modeMAC media access controlMAEP middle latency auditory evoked potentialMAP mean arterial pressureMARS adsorbent recirculating systemMC microcontrollerMCS mechanical circulatory supportMCSS mechanical circulatory support systemMDCT multidetector computed tomographyMDD medical device directiveMDM manage document messageMDR medium-dose rateMDS move during scanMDS myelodysplastic syndromeMDX dystrophic miceME medical electricalME medical engineeringMEA multielectrode arrayMEDARPA medical augmented reality for patientsMEDDEV medical deviceMEG magnetoencephalographyMEMS microelectromechanical systemMEP motor evoked potentialMEQ modified essay questionmfERG multifocal ERGMFI micro flex interconnection techniqueMFT multifrequency tympanometryMHLW Ministry of Health, Labor and WelfareMIB medical information busMICS medical implant communication serviceMIP maximum-intensity projectionMIS minimally invasive surgery
MITOS multimodality image-guided diagnosisand therapy setup
MLC multileaf collimatorMLEM maximum-likelihood expectation
maximizationMLRA middle latency response audiometryMMN mismatch negativityMMS multimedia message serviceMMT manual muscle testingMOD magnetooptical discMOG magnetooculographyMPDA microphotodiode arrayMPE maximum permissible exposureMPI magnetic particle imagingMPI master patient indexMPPS modality performed procedure stepMPR multiplanar reconstructionMPS magnetic particle spectrometerMPS maximum physical frame sizeMR magnetic resonanceMRI magnetic resonance imagingMRS MR spectroscopyMRSA methicillin-resistant staphylococcus
aureusMRT magnetic resonance tomographyMRT minimum resolvable temperatureMRgFUS MR-guided focused ultrasoundMS multiple sclerosisMSCT multislice computer tomographyMSLT multiple sleep latency testMT movement timeMTF modulation transfer functionMTT mean transit timeMUAP motor unit action potentialMUP motor unit potentialMV minute volumeMVCT megavoltage computer tomographyMVP MedBiquitous virtual patientMWIR mid-wavelength infraredMWT maintenance of wakefulness testMb myoglobinMetHb methemoglobinMi mechanical index
N
NA numerical apertureNAA n-acetyl-aspartateNAL National Acoustics LaboratoriesNAS network attached storageNASPE North American Society of Pacing and
ElectrophysiologyNBG NASPE/BPEG generic pacemaker codeNBI narrowband imagingNBP noninvasive blood pressure
List of Abbreviations XLIII
NCIGT National Center for Image GuidedTherapy
nCPAP nasal continuous positive airway pressureNCV nerve conduction velocityNDIR nondispersive infraredNDT nondestructive testingNE neutral electrodeNEDT noise equivalent differential temperatureNET noise equivalent temperatureNETD noise equivalent temperature differenceNFD nephrogenic fibrosing dermopathyNFI nerve fiber indicatorNIBP noninvasive blood pressureNICU neonatal intensive care unitNIHL noise-induced hearing lossNIP needle image plateNIR near-infraredNIRS near-infrared spectroscopyNIV noninvasive ventilationNMES neuromuscular electrical stimulationNMR nuclear magnetic resonanceNN nearest neighborNOTES natural orifice translumenal endoscopic
surgeryNP neural pathwayNRZ no return to zeroNSF nephrogenic systemic fibrosisNTC negative-temperature coefficientNTP normal transmission periodNTSC National Television System CommitteeNYHA New York Heart Association
O
O2Hb oxyhemoglobinO2C oxygen to seeOAE otoacoustic emissionOAR organ at riskOCT optical coherence tomographyODI oxygen desaturation indexOEG open ear gainOHC outer hair cellOID object identifierOKN optokinetic nystagmusOL-HDF online hemodiafiltrationOME otitis media with effusionONH optic nerve headOP operative fieldOPCAB off-pump coronary artery bypassOPS classification of operational procedures
(Germany)OQ operational qualificationOR operating roomORC oxygen ratio controllerORM order message
ORU observation results unsolicitedOSA obstructive sleep apnoeaOSCE objective structured clinical examinationOSI open system interconnectionOT operating theaterOXI oximetry
P
PA polyamidePAAM polyacrylamidePACC patient contact controlPACS picture archiving and communication
systemPAD peripheral arterial diseasePAL pharmaceutical affairs lawPAN polyacrylonitrilePAP pulmonary artery pressurePAPm mean pulmonary artery pressurePAT parallel acquisition techniquePAV proportional assist ventilationPAW airway pressurePBL problem-based learningPC peak clippingPC personal computerPC pressure controlledPC-AC pressure control–assist controlPC-APRV pressure control airway pressure release
ventilationPC-BIPAP pressure control, biphasic positive airway
pressurePC-CMV pressure control-continuous mandatory
ventilationPC-SIMV+ pressure control-synchronized
intermittent mandatory ventilation plusPCB printed circuit boardPCR principal component regressionPCS patient control systemPCV pressure-controlled ventilationPCWP pulmonary capillary wedge pressurePDA patent ductus arteriosusPDA personal digital assistantPDCA plan–do–check–actPDD percentage depth dosePDF portable document formatPDM permanent dynamic monitoringPDMA Pharmaceuticals and Medical Devices
AgencyPDR pulsed-dose ratePDT photodynamic therapyPDw proton density weightingPE parallel elementPE protective earthPEEP positive end-expiratory pressurePEF peak expiratory flow
XLIV List of Abbreviations
PEG polyethylene glycolPELV protective extra low voltagePEMS programmable electrical medical systemPENG photoelectronystagmographyPERG pattern ERGPET positron emission tomographyPF pulmonary functionPFO patent foramen ovalePFT pulmonary function testPHS personal health systemPI perfusion indexPID proportional–integral–derivativePII pulse intensity integralPIN personal identification numberPLS partial least-squaresPLV pressure-limited ventilationPMMA polymethylmethacrylatePMS periodic leg movementPMV pump minute volumePNS peripheral nerve stimulationPNS peripheral nervous systemPPG photoplethysmogramppm parts per millionPPS proportional pressure supportPQ performance qualificationPRF proton resonance frequencyPRF pulse repetition frequencyPRVC pressure regulated volume controlledPS power supplyPS pressure supportPSN pelvic splanchnic nervePSu polysulfonePT perception thresholdPT programmed teachingPTA percutaneous transluminal angioplastyPTCA percutaneous transluminal coronary
angioplastyPTS permanent threshold shiftPTT pulse transit timePTV planned target volumepTX parallel transmitPUK personal unblocking keyPUR polyurethanePUVA psoralen and ultraviolet APVAD paracorporeal ventricular assist devicePVARP postventricular atrial refractory periodPVC polyvinyl chloridePVDF polyvinyl difluoridePVDF polyvinylidene fluoridePVI pleth variability indexPVP polyvinylpyrrolidonePVR pulmonary vascular resistancePW pulsed wavePW pulse widthPWC pulse working capacityPWV pulse wave velocity
Q
QBE query by exampleQM quality managementQMS quality management systemQSRL Q-switched ruby laserQT quasi-tripoleQWIP quantum-well infrared photodetectorQoS quality of service
R
RAID redundant array of independent discsRARE rapid acquisition with relaxation
enhancementRBC red blood cellRCD residual current protective deviceRCTX radiochemotherapyRDI respiratory disturbance indexRECD real ear to coupler differenceREFET reference FETREM rapid eye movementRF radiofrequencyRFID radiofrequency identificationRGB red–green–blueRGRT respiratory guided radiotherapyRIM reference information modelRIS radiology information systemRKI Robert Koch InstituteRLN recurrent laryngeal nerveRMS root mean squareROI region of interestROM range of motionRPE retinal pigment epitheliumRR respiration rateRSNA Radiological Society of North AmericaRST rotation, scale, and translationRT radiation therapyRV residual volumeR&TTE radio and telecommunications terminal
equipment
S
S-MAC sensor MACSA sinoatrialSAN storage area networkSAP systemic arterial pressureSAR specific absorption rateSARS severe acute respiratory syndromeSB spontaneous breathingSBRT stereotactic body radiation therapySCI steered compound imagingSCI spinal cord injurySCORM sharable courseware object reference
model
List of Abbreviations XLV
SCP slow cortical potentialSD standard deviationSE spin echoSE series elementSEM scanning electron microscopysEMG spontaneous electromyographySENSE sensitivity encodingSEP somatosensory evoked potentialSET signal extraction technologySF standard flashSFOAE stimulus frequency otoacoustic emissionSIDS sudden infant death syndromeSIMV synchronized intermittent mandatory
ventilationSISI short increment sensitivity indexSLARSI sacro-lumbar anterior root stimulator
implantSMD surface mount deviceSME small and medium-sized enterprisesSMR sensorimotor rhythmicSMS short message serviceSNOMED Systematized Nomenclature of MedicineSNR signal-to-noise ratioSOA service oriented architectureSOAE spontaneous otoacoustic emissionSOC system-on-a-chipSPECT single photon emission computed
tomographySPGR spoiled gradient recalledSPIN speech in noiseSPIO superparamagnetic iron oxideSPL sound pressure levelSPN-CPAP spontaneous-continuous positive airway
pressureSPN-CPAP/PS spontaneous continuous positive airway
pressure/pressure supportSPN-PPS spontaneous proportional pressure
supportSQUID superconductive quantum interference
deviceSRS stereotactic radiosurgerySRT stereotactic radiotherapySRT speech perception thresholdSSEP somatosensory evoked potentialSSVEP steady-state visually evoked potentialSTAN ST waveform analysisSTIR short-tau inversion recoverySTPD standard temperature and pressure, drySTR scotopic threshold responseSV stroke volumeSVC superior vena cavaSVES ventricular super-extrasystoleSVR systemic vascular resistanceSWI susceptibility-weighted imagingSWIR short-wavelength infraredSkBF skin blood flow
T
TA technical assistantTAH total artificial heartTASP téléassistance en soins de plaiesTBI total body irradiationTC tube compensationTCI target-controlled infusionTCP/IP transmission control protocol/Internet
protocolTDI tissue Doppler imagingTDMA time-division multiple accessTE time of echoTEB thoracic electrical bioimpedanceTEC thermoelectric coolerTEE transesophageal echocardiographytEMG triggered electromyographyTENS transcutaneous electrical nerve
stimulationTEOAE transient evoked otoacoustic emissiontf-LIFE thin-film longitudinal intrafascicular
electrodeTFT thin-film technologyTFT thin-film transistorTHC tissue hemoglobin measurementTHI tissue hemoglobin indexTIFF tagged image file formatTIVA total intravenous anesthesiaTLC total lung capacityTLD thermoluminescent dosimeterTMP transmembrane pressureTMS transcranial magnetic stimulationTN-S terre neutre séparéTOI tissue oxygenation indexTPR total peripheral resistanceTPS treatment planning systemTPU thermoplastic polyurethaneTR time of repetitionTRICKS time-resolved imaging of contrast
kineticsTSE turbo spin echoTSEBT total skin electron beam therapyTT true-tripoleTTDT threshold tone decay testTTP time to peakTTS temporary threshold shiftTTS transdermal therapeutical systemTUR transurethral resectionTUR-B transurethral resection, bladderTUR-P transurethral resection, prostateTV televisionTWIST time-resolved imaging with interleaved
stochastic trajectoryTimCT total imaging matrix with continuous
table movementToF-MRA time-of-flight MR angiography
XLVI List of Abbreviations
U
UCUM Unified Code for Units of MeasureUDP user datagram protocolUEA Utah electrode arrayUITDD ultrasound-induced targeted drug
deliveryULF ultralow frequencyUPG ultrasound pneumographyUPS uninterruptible power supplyURR urea reduction rateUS ultrasoundUSB universal serial busUSRDS United States Renal Data SystemUV ultraviolet
V
VAD ventricular assist deviceVAH Verbund für angewandte HygieneVAP ventilator-associated pneumoniaVC vital capacityVC volume controlledVC-AC volume control-assist controlVC-MMV volume control-mandatory minute
volumeVC-SIMV volume control-synchronized intermittent
mandatory ventilationvCJD variant Creutzfeldt–Jakob diseaseVCT volume computer tomographyVDE Verband der Elektrotechnik, Elektronik
und InformationstechnikVEP visual evoked potentialVES ventricular extrasystoleVG volume guaranteeVLAN virtual local area networkVLF very low frequency
VLWIR very longwave infraredVNA vendor-neutral archiveVOG videooculographyVOR vestibulo-ocular reflexVOT vascular occlusion testVR ventricular rateVR virtual realityVRE vancomycin-resistant enterococcus
faeciumVRT volume rendering techniqueVSV vacuum–steam–vacuumVT tidal volumeVTC videoteleconference
W
W3C World Wide Web ConsortiumWBT web-based trainingWD washer-disinfectorWDRC wide dynamic range compressionWHMS wireless health monitoring systemWIM wireless interface moduleWLAN wireless local area networkWM white matterWOB work of breathingWPW Wolff–Parkinson–White-syndromeWSN wireless sensor network
X
XDS cross-enterprise document sharingXML extensible markup language
Z
ZVEI Zentralverband der ElektrotechnischenIndustrie