X线数字减影血管造影设备通过(DSA)鉴定

上海市科学技术委员会重点科研项目——X线数字减影血管造影设备(DSA)于九月廿六日在市科委主持下,通过科研鉴定。该项目由上海医疗器械厂和中国科学院自动化研究所共同研制,经上海第二医科大学附属第九人民医院临床试用,从颅脑到肾脏等多种脏器的血管造影,经计算机数字减影处理后的影象质量、对比度及分辨率等主要技术指标、均达到了国际上八十年代的水平、填补了国内空白。DSA是继X-CT之后,在放射医学领域中又一次新的突破。八十年代初期,DSA在世界上才初步商品化。目前进口一套这样的设备需要50～60万美元。国内凡是开展血管造影的大、中型医疗单位,都很需要,因此国产DSA的     

冠状动脉CT造影对冠心病的临床诊断价值研究

目的：探讨研究冠状动脉CT造影检查对冠心病的临床诊断价值。方法：收集我院2012年1月至2013年10月共计70例临床怀疑为冠心病的患者,对这些患者分别进行冠状动脉CT造影检查和数字减影冠状动脉造影（DSA）检查,记录这两项检查所得结果及数据,以检查数据为基础对冠状动脉CT造影和数字减影冠状动脉造影检查的临床实验效果进行对比研究。结果：70例病人均可顺利完成以上两种检查,按照数字减影冠状动脉造影检查的标准,冠状动脉CT造影的敏感度为92.2%,特异度为97.4%、阳性预测率为90.5%、阴性预测率98%。结论：相对于数字减影冠状动脉造影检查,冠状动脉CT造影检查是一种更加安全、可靠、无创且更具临床指导意义的检测技术,因此可以推荐作为冠心病诊断的首选方法。     

冠状动脉CT造影对冠心病的临床诊断价值研究

目的:探讨研究冠状动脉CT造影检查对冠心病的临床诊断价值。方法:收集我院2012年1月至2013年10月共计70例临床怀疑为冠心病的患者,对这些患者分别进行冠状动脉CT造影检查和数字减影冠状动脉造影(DSA)检查,记录这两项检查所得结果及数据,以检查数据为基础对冠状动脉CT造影和数字减影冠状动脉造影检查的临床实验效果进行对比研究。结果:70例病人均可顺利完成以上两种检查,按照数字减影冠状动脉造影检查的标准,冠状动脉CT造影的敏感度为92.2%,特异度为97.4%、阳性预测率为90.5%、阴性预测率98%。结论:相对于数字减影冠状动脉造影检查,冠状动脉CT造影检查是一种更加安全、可靠、无创且更具临床指导意义的检测技术,因此可以推荐作为冠心病诊断的首选方法。     

烟雾病5例临床分析

目的：研究烟雾病（moyamoya disease,MMD）的临床及影像学特征。方法：回顾性分析5例烟雾病患者,分析其临床及影像学特点。结果：本组病例既往均无阳性病史,中、青年起病,男性居多,均以缺血性脑血管病起病,肢体瘫痪不重,经颅多普勒（TCD）及头颅核磁改变明显,数字减影血管造影（DSA）检查均存在血管闭塞及侧支开放,烟雾血管网形成,1例MRA证实烟雾血管网形成。结论：对于无既往史的中、青年脑卒中患者,要考虑MMD的可能,需完善TCD、头核磁检寻找证据,最后完善数字减影血管造影确诊。     

烟雾病5 例临床分析

目的:研究烟雾病(moyamoya disease,MMD)的临床及影像学特征。方法:回顾性分析5例烟雾病患者,分析其临床及影像学特点。结果:本组病例既往均无阳性病史,中、青年起病,男性居多,均以缺血性脑血管病起病,肢体瘫痪不重,经颅多普勒(TCD)及头颅核磁改变明显,数字减影血管造影(DSA)检查均存在血管闭塞及侧支开放,烟雾血管网形成,1例MRA证实烟雾血管网形成。结论:对于无既往史的中、青年脑卒中患者,要考虑MMD的可能,需完善TCD、头核磁检寻找证据,最后完善数字减影血管造影确诊。     

时间减影在静脉肾盂造影中的应用价值研究

目的探讨数字X线机(DFR)时间减影对静脉肾盂造影的诊断价值,并与常规单纯DFR静脉肾盂造影比较。方法对38例运用数字(DFR)静脉肾盂造影的检查者,同时采用时间减影进行分析。检查结果正常16例,肾盂积水、肾结石、输尿管畸形、输尿管结石等22例。结论数字静脉肾盂造影检查 时间减影检查,较好地克服了传统造影方法的不足,为泌尿系统的诊断和治疗提供了更全面和确切的依据,取得了较好的临床效果。     

盆腔疾病髂内动脉栓塞术的研究进展

髂内动脉栓塞是盆腔出血性疾病和肿瘤治疗的重要治疗方法,常规采用Seldinger技术,从一侧股动脉径路两侧髂内动脉选择性与超选择性插管。髂内动脉是盆腔脏器主要供血来源,根据数字减影动脉造影术（Digital subtraction arteriography,DSA）功能可分为：常规DSA,旋转DSA,平板数字减影旋转血管造影与三维血管重建和路图技术。栓塞剂可分为颗粒型和液态型栓塞剂。本文综述了盆腔疾病髂内动脉栓塞术近年来的研究进展。     

盆腔疾病骸内动脉栓塞术的研究进展

骼内动脉栓塞是盆腔出血性疾病和肿瘤治疗的重要治疗方法,常规采用Seldinger技术,从一侧股动脉径路两侧骼内动脉选择性与超选择性插管.骼内动脉是盆腔脏器主要供血来源,根据数字减影动脉造影术(Digital subtraction arteriography,DSA)功能可分为:常规DSA,旋转DSA,平板数字减影旋转血管造影与三维血管重建和路图技术.检塞剂可分为颗粒型和液态型栓塞剂.本文综述了盆腔疾病骼内动脉检塞术近年来的研究进展.     

2 型糖尿病下肢血管病变评估方法的研究进展

2型糖尿病的发病率逐年增高,下肢血管病变是其严重并发症之一,其临床特点主要有间歇性跋行、静息痛、缺血性坏疽等,严重者可发生肢端坏疽,一旦出现以上症状,治疗相当困难,甚至导致截肢。因此尽早发现并预防该并发症的发生,对于改善患者预后有着极重要的临床价值[1]。目前临床上对于2型糖尿病下肢血管病变的评估方法众多,包括间歇性跛行、静息痛等临床表现,足部动脉搏动检查,踝-肱血压指数,经皮氧分压检查,彩色多普勒超声检查,CT血管成像,MR血管成像,数字减影血管造影等。在现今超声及影像设备和技术飞速发展的大背景下,本文对以上方法的价值、局限性及其最新研究进展作一综述。     

VCTDSA联合CT灌注成像在急性缺血性卒中诊断运用探究

目的：探讨64层容积CT数字减影血管造影（Volume computed tomography digital subtraction angiography, VCTDSA）联合CT灌注成像在急性缺血性卒中诊断价值。方法：回顾性分析45例临床确诊为急性缺血性卒中患者的临床资料,分别给予VCTDSA与CT灌注成像处理,分析这两种技术对急性缺血性卒中患者的诊断敏感性和特异性。结果：45例患者检查有颅内有不同部位出血灶,多见于脑室,均伴有不同程度的异常血管网形成,其中VCTDSA图像质量优于CT灌注成像,VCTDSA较DSA可准确显示和测量动静脉瘘口大小,VCTDSA与MRA在瘤体长轴、瘤颈的比较中无显著性差异。结论：与其他减影CTA比较,VCTDSA联合CT灌注成像在急性缺血性卒中患者的诊断中具有优势。     

医院医疗器械维修中存在的问题及维修管理对策研究

近几年来,随着科学技术的发展和医院规模的扩大,社会对医疗技术要求不断提高,因此,高端医疗器械和新型医疗设备需求加大,医疗器械管理与维修也需跟进。医疗器械的正常使用在医疗工作中有着举足轻重的作用,可提高医疗人员的工作效率,提升临床诊治的水平,但其在改善医疗条件的同时也存在一系列的问题,若无法保质和及时维修医疗器械,对正常医疗设备的使用具有严重影响,延误患者的就诊与治疗。目前医院医疗器械维修中存在的维修人员整体素质偏低、管理机制不健全、维修技术落后、医疗器械维修人员不足、缺乏积极性及再学习的机会、医疗器械缺乏定期保养和管理等实际问题,导致医疗器械维修效率低,本文就以上问题展开讨论,旨在为医院维修管理的制定提供参考。     

医疗设备软件维修与调整

介绍了医疗设备软件维修必须具备的知识,DSA机与培养仪软件维修实例。同时还介绍了医疗设备的调整的方法,用于排除故障的经验。     

医院设备利用率管理的探究

分析了医院医疗设备利用率管理的现状,提出了医疗设备利用率管理的前期工作与实施方法。建立设备的性能价值评定标准以及加强设备的维护保养工作都是提高设备利用率的有效途径。     

Classifying medical devices according to their maintenance sensitivity: a practical, risk-based approach to PM program management

Many medical equipment items need periodic attention to ensure that they continue to operate properly and safely; and most inspecting agencies require healthcare facilities to have a competent equipment maintenance program that is focused on the most critical of those devices. There is however a long-standing lack of consensus on how best to determine which devices should be included in this critical device category, and which can reasonably be excluded. A new methodology is proposed for establishing a logical, fact-based framework for determining which devices should be included. It is based in part on a new FDA-sanctioned definition of what an appropriate regimen of planned maintenance activities for a medical device should include. This new definition addresses the medical device users' concerns about periodic performance verification and safety testing as well as detecting and correcting the wear or progressive deterioration of any non-durable parts, which is the primary focus of the conventional preventive maintenance programs found in less critical industries. The analytical approach proposed utilizes technical information that is either already available or which can be easily developed. It characterizes each different device by means of a 3-letter maintenance sensitivity profile that can be used to analyze the effectiveness of the maintenance procedures as well as quantify the device's sensitivity to planned maintenance. A collaborative effort to assemble and organize this data would provide the industry with a sound, logical platform for narrowing the scope of most PM programs and allow us to redirect a significant amount of scarce technical manpower into more productive activities such as device user training.     

医院计算机化医疗设备的维护管理

现代医疗设备大都采用了计算机化设计,分析了目前医院拥有的计算机现状、医疗设备的分类和管理。最后,提出了维护管理措施。     

Product liability aspects of bioengineering

The introduction of the Consumer Protection Act 1987 brought the problems of product liability directly into hospital bioengineering and medical physics departments. This law makes great demands upon manufacturers, but also on suppliers and maintainers of medical equipment. Departments which manage medical equipment carry a responsibility for ensuring the requirements of product liability are known by all those whose actions may affect the potential of a piece of equipment to injure or damage a patient. This paper addresses these problems from a bioengineering, rather than a legal, viewpoint. The problems of design, manufacture, modification, maintenance and use are discussed and examples of potential problems are identified. The paper concludes that as long as good standards of quality control and professionalism are applied in bioengineering and medical physics departments then there is little to be feared from this piece of legislation.     

Integrated software system for improving medical equipment management

The evolution of biomedical technology has led to an extraordinary use of medical devices in health care delivery. During the last decade, clinical engineering departments (CEDs) turned toward computerization and application of specific software systems for medical equipment management in order to improve their services and monitor outcomes. Recently, much emphasis has been given to patient safety. Through its Medical Device Directives, the European Union has required all member nations to use a vigilance system to prevent the reoccurrence of adverse events that could lead to injuries or death of patients or personnel as a result of equipment malfunction or improper use. The World Health Organization also has made this issue a high priority and has prepared a number of actions and recommendations. In the present workplace, a new integrated, Windows-oriented system is proposed, addressing all tasks of CEDs but also offering a global approach to their management needs, including vigilance. The system architecture is based on a star model, consisting of a central core module and peripheral units. Its development has been based on the integration of 3 software modules, each one addressing specific predefined tasks. The main features of this system include equipment acquisition and replacement management, inventory archiving and monitoring, follow up on scheduled maintenance, corrective maintenance, user training, data analysis, and reports. It also incorporates vigilance monitoring and information exchange for adverse events, together with a specific application for quality-control procedures. The system offers clinical engineers the ability to monitor and evaluate the quality and cost-effectiveness of the service provided by means of quality and cost indicators. Particular emphasis has been placed on the use of harmonized standards with regard to medical device nomenclature and classification. The system's practical applications have been demonstrated through a pilot evaluation trial.     

Microvascular surgery

LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Describe the common room set-up, medical considerations, and technical equipment necessary to perform microvascular surgery. 2. Describe the common arterial and venous techniques in performing microvascular surgery. 3. Recognize the common flap types along with their vascular supply and innervation used for microvascular surgery. 4. Describe common techniques for flap monitoring. 5. Describe techniques and medications for thrombolytic therapy. 6. Describe common medical conditions that may preclude an optimal result in microvascular surgery. SUMMARY: This article will explore common approaches to microsurgery. It is anticipated that the readers can utilize this article for maintenance of certification educational components and take the principles outlined and apply them to their daily practice.     

Equipment management: the Cinderella of bio-engineering

In recent years the work associated with equipment maintenance has become increasingly important. As concern for efficiency grows, the use of expensive equipment is questioned more closely. The running costs associated with such equipment are seen to be of growing relevance. Nonetheless, it is important to examine the work of maintenance departments, to identify the salient features and to ensure that the service is run as efficiently as possible. It becomes clear that the necessary support is considerably more than mere maintenance. Complete equipment management must be provided. Further, appropriate performance indicators must be developed, not only to allow overall efficiency to be examined, but also to assist in the daily running of the service. Examples are drawn from a typical equipment management department.     

Use of personal protective equipment for respiratory protection

Management of hazards in biomedical research facilities requires the application of the traditional industrial hygiene responsibilities of anticipation, recognition, evaluation, and control to characterize the work environment, evaluate tasks and equipment, identify hazards, define exposure groups, and recommend controls. Generally, the diversity and unique characteristics of hazards faced by laboratory and animal facility employees and the short-term and low-level nature of the exposures factor into the selection of proper exposure control measures in the laboratory. The proper selection of control measures is based on a hierarchy of elimination and minimization by engineering controls, followed last by personal protective equipment when exposures cannot be eliminated. Once it is decided that personal protective equipment is needed, specific regulations and guidelines define safety standards for research facilities, including the elements of a sound respiratory protection program. These elements include respirator selection (including appropriate protection factors), medical evaluation, fit testing, training, inspection, maintenance and care, quality, quantity and flow of breathing air, and routine and emergency use procedures.