1. 0
Hashemite University
Faculty of Engineering
Biomedical Engineering Department
Training Report at First National Medical Services
“FNMS” Siemens
By : Ayham Nayef Al-Kayed
ID Number: 1133738
2. 1
Summary
Training Course started at 8/6/2015, and it was divided into two parts;
Theoretical part and Practical part. Theoretical part was lectures about the
company's products (x-ray, CT, MRI, Radio therapy, US …) and was
done by the engineers in FNMS training center.
Practical part was going on services calls or service routine check ―PM‖,
in average of 2 or 3 visits / week. The visits were well organized as
example we went to King Husain Medical City ( KHMC ) and we saw the
cyclotron . During the theoretical part (the small instruments like US)
there was some practical work such as the one we did on the ultrasound
device in the class room in company's training center.
The main supervisor of training course was Eng. Adel Manoun, with help
of other engineers such Eng. Awad, Eng. Basel, Eng. Sanad , Eng. Sami,
and Eng. Hazem , and all of them were very helpful persons , they guide
us to learn well how to deal with medical imaging devices .
3. 2
TABLE OF CONTENTS
CHAPTER 1 Introduction……………………………………………..4
1.1 Company Profile……………………………………………...4
1.2 Company Mission……………………………………………4
1.3 Company Vision………………………………………………4
1.4 Company Achievement……………………………………….5
CHAPTER 2 Company Products ……………………………………..6
2.1 Angiography ………………………………………………….6
2.2 Computed tomography (CT) ………………………………….7
2.3 Fluoroscopy……………………………………………………8
2.4 Magnetic resonance (MR) …………………………………….8
2.5 Radiography ……………………………………………………8
2.6 Ultrasound ……………………………………………………..9
2.7 Mammography …………………………………………………9
2.8 Radiation oncology …………………………………………….9
CHAPTER 3 Theoretical Part (Lectures)……………………………….10
CHAPTER 4 Practical Part (Service calls)…………………………...…12
4.1 King Husain Medical City (KHMC)……………………..….….12
4.2 Luzmila Hospital …………………………………………...…..15
4.3 Al-Basheer hospital ……………………………………..….…..16
4.4 FNMS HQ ………………………………………………………17
4. 3
4.5 Jordan University Hospital (JUH) ………………………………18
4.6 Arabic Medical Center ………………………………………….19
TABLE OF FIGURES
Figure [A]……………………………………………………..……...5
Figure [B]……………………………………………………..………6
Figure [C]…………………………………………………….……….7
Figure [D]…………………………………………………….……….7
Figure [E]…………………………………………………………..….8
Figure [F]………………………………………………………..……12
Figure [G]………………………………………………………….…13
Figure [H]………………………………………………………….…13
Figure [I]…………………………………………………………...…14
Figure [J]…………………………………………………………...…14
Figure [K]………………………………………………………..……15
Figure [L]…………………………………………………………..…16
Figure [M]……………………………………………………….…….17
Figure [N]………………………………………………………...……18
Figure [O]…………………………………………………………...…19
Figure [P]……………………………………………………...………19
5. 4
1 Introduction
1.1 Company Profile
While the majority of the Middle East countries are going through
difficult times because of political and / or economic instability, we, at
First National Medical Services kept our faith and belief in our people
and our country; we continued to develop our business and create more
job opportunities while hoping for prosperous and peaceful future. Since
the date we started, our strategy was to establish close ties with the most
reputable Doctors, heath centers and hospitals. Thanks to our Service and
Sales team which they gave their professional knowledge and their full
determination to meet the customer needs; Because of those unknown
soldiers, we became one of the most distinguished companies in the area.
For you my colleagues, at First National Medical Services, I express my
gratitude for your high professionalism; it is my great honor to be one of
such wonderful team. Finally, allow me to summarize the attitude which
brought us to the level we reached with those few words: We do not
follow standards, we set them! [1]
1.2 Company Mission:
To be the choice for our customers and suppliers; delivering sustained
growth and live the values of our organization.[1]
1.3 Company Vision:
We aim to reach more in order to be the prime growth sectorby offering
value-added services, and investment delivering superior quality products
with exceptional customer service. [1]
1.2.1Our Values are SHARP:
Service: Principals and customers, both internal and external, will all
be treated to consistently high standards of service excellence. Total
customer satisfaction is the result of a continuous focus on quality.
Honesty, integrity and trust: These three words govern the approachwe
take to everything we do;how we deal with people; how we take
decisions.[1]
6. 5
1.4 Achievement:
As achievers we are goal orientated, as we are passionate about success.
We constantly challenge the status quo by being innovative and creative.
Respectand People: We will continue to create an environment where
individuals and teams can flourish. We are committed to appreciate effort
and reward results.[1]
Figure [A]:Organization Chart[1]
7. 6
2 Company Products
2.1 Angiography:
The Artiszee family is an entirely new family for interventional imaging in
radiology and cardiology. With Artiszee we introduce enhanced imaging
capabilities and keep you on the cutting edge of technology.Highlight of
the family is Artiszeego, a highly flexible multi-axis system.[2]
2.1.1 Universal angiography:
Artis zee imaging systems for diagnosis and intervention of general
vascular disease.[2]
Figure [B]:Universal angiography[2]
2.1.2 Card angiography:
The Artiszee family is an entirely new family for interventional imaging.
Artiszee features a complete portfolio for interventional cardiology,
whether floor- or ceiling-mounted, biplane or with Magnetic Navigation.
Highlight of the family is Artiszeego, a highly flexible multi-axis system
based on robotic technology.[2]
2.1.3 Surgical angiography suites:
Hybrid procedures requiring OR infrastructure and angiography systems
are revolutionizing surgical therapy. [2]
8. 7
Figure [C]:Surgical angiography[2]
2.2 Computed tomography (CT):
Leading healthcare institutions and clinical experts trust SOMATOM's
excellent performance in both daily routine and clinical research. Join us
in this journey through the world of Computed Tomography and discover
how Siemens, the recognized innovation leader in CT, can work for
you.[2]
2.2.1 Dual source CT:
Moving beyond the simple adding of detector rows, the SOMATOM
Definition uses two X-ray sources and two detectors at the same time. For
more information please click here. [2]
2.2.2 Multislice CT:
By simultaneously scanning several slices of the body, the scan time can
be reduced significantly and the smallest details can be scanned within
practicable scantimes.[2]
Figure [D]:Multislice CT[2]
9. 8
2.2.3 Open bore CT:
Combines the advantages of a large bore CT with advanced multislice CT
technology.[2]
Figure [E]:Open bore CT[2]
2.3 Fluoroscopy:
Siemens fluoroscopysystems provide the capability for a wide range of
applications, from fluoroscopy, including gastro-intestinal and genito-
urinary exams, to special procedures, to routine radiographic work. The
productselection also provides a choice of under-table or over-table
systems, depending on the customer's preference. Additionally, Siemens
also offers a productspectrum to fit every budget, from fully digital, to
cassette analog systems.[2]
2.4 Magnetic resonance (MR):
Welcome to a new era of MRI. We‘ve taken Tim (Total imaging matrix)
to the 4G level to unlock imaging power like never before. While Dot
Day).optimizing throughput) engine multiplies the power of Tim to make
precise scanning, perfectly easy – for everyone. Together they will
transform your day with up to 30% higher productivity.[2]
2.5 Radiography:
Siemens' radiography systems are designed together with users to
optimize workflow and improve efficiency and convenience in your
10. 9
radiography department. To provide a unique and optimal approachto
your daily routine we offer a productspectrum to fit every budget, from
fully digital with flat detector technology, analog cassette to mobile X-ray
systems. We focus on integrating cutting-edge medical technology and
innovative information technology into your clinical practice, thus
allowing you to concentrate on what really matters - the patient.[2]
2.6 Ultrasound:
Your patients depend on you to provide accurate diagnoses and help them
to make the best decisions for their care. That‘s why Siemens never stops
exploring the boundaries of medicine and technology – to make
discoveries in ultrasound that producea positive difference.[2]
2.7 Mammography:
Clinical studies have proven that with early detection, the mortality rate
of breast cancer is reduced significantly. This is why Siemens is
dedicated to providing an innovative, synergistic approachto meet the
highest requirements in mammography. Our portfolio comprises analog
and digital mammography solutions, biopsysystems as well as reading
and reporting workplaces. [2]
2.8 Radiation oncology:
Fighting cancer is a challenge. We are convinced that successfulradiation
therapy calls for speed and precision. Siemens‘ portfolio for radiation
oncology provides fast and focused solutions for radiotherapy. Make a
difference in your patients‘ lives – with the right therapy and solutions.[2]
11. 10
3 Theoretical Part (Lectures)
The lectures were done by engineers of company ‗FNMS‘; it was based
on their own experience since every one of them is specialized in one or
two fields of devices. Down below are the topics that were covered
during the course.
Topics covered:
1- X-Ray: the lectures included everything about the X-ray machine, how
it works, and how the x-rays are generated in X-ray tube. After showing
all of the x-ray parts and how they work we start dealing with the trouble
shooting the machine which is based on the engineer experience in the
field.
As we came to know the main part that needs to be replaced is the x-ray
tube other than that the machine needs calibration and routine check ‗
using phantoms‘ , after this we became famieler to deal with x-ray
machine .
2- NuclearMedicine: which includes the cyclotron, PET and radioactive
materials, as will be discussed in the practical part the cyclotron is where
the radioactive materials are made by accelerating hydrogen ions in a
circular path. The PET (Positron Emission Tomography) is the machine
that takes the medical photos of the patient after being injected with FDG
(Fluorodoxy glucose) a radioactive pharmaceutical mainly used in PET
scan in Jordan.
3- CathLab: A catheterization laboratory or CathLab is an examination
room in a hospital or clinic with diagnostic imaging equipment used to
visualize the arteries of the heart and the chambers of the heart and treat
any stenosis or abnormality found. A typical 'CathLab' will consistof:
-Patient Couch
-A floor or ceiling mounted Image intensifier
-Set of viewing monitors
-Real-time ECG/Blood pressure/Oxygen Saturation measurements with
software to record and measure these when needed
Injector Pump used for imaging the Left Ventricle or Aorta-
12. 11
-X-ray software for the recording and playback of the Fluoroscopyruns
acquired during the procedure
-Diagnostic Catheters
-Guide catheters
-Angioplasty balloons
-Stents (drug eluting and bare metal)
4- Ultrasound: is an ultrasound-based diagnostic imaging technique used
for visualizing subcutaneous bodystructures including tendons, muscles,
joints, vessels and internal organs for possible pathology or lesions.
Obstetric sonography is commonly used during pregnancy and is widely
recognized by the public. In physics, the term "ultrasound" applies to all
sound waves with a frequency above the audible range of normal human
hearing, about 20 kHz. The frequencies used in diagnostic ultrasound are
typically between 2 and 18 MHz
5- Lithotripsy: is a medical procedure involving the physical destruction
of hardened masses like kidney stones, bezoars or gallstones. The
lithotripter attempts to break up the stone with minimal collateral damage
by using an externally-applied, focused, high-intensity acoustic pulse.
The sedated or anesthetized patient lies down in the apparatus' bed, with
the back supported by a water-filled coupling device placed at the level of
kidneys. A fluoroscopic x-ray imaging system or an ultrasound imaging
system is used to locate the stone and aim the treatment.
6- Computed Tomography(CT): is a medical imaging procedure that
uses computer-processedX-rays to producetomographic images or
'slices' of specific areas of the body. These cross-sectionalimages are
used for diagnostic and therapeutic purposes in various medical
disciplines. Digital geometry processingis used to generate a three-
dimensional image of the inside of an object from a large series of two-
dimensional X-ray images taken around a single axis of rotation.
7- Magnetic Resonance Imaging (MRI): An MRI scanner is a device in
which the patient lies within a large, powerful magnet where the magnetic
field is used to align the magnetization of some atomic nuclei in the body,
and radio frequency magnetic fields are applied to systematically alter the
alignment of this magnetization. This causes the nuclei to produce
13. 12
a rotating magnetic field detectable by the scanner—and this information
is recorded to constructan image of the scanned area of the body.
4 Practical Part (Service calls)
The practical part was the service calls mainly and the routine check as
required in the maintenance contract, so there were many visits to many
hospitals as KHMC, KHCC, Lozmilla hospital, the university hospital
and many others.
4.1 King Husain Medical City (KHMC):
The visit there was for a routine check on the cyclotron ( it‘s a device
used to producethe radioactive material that the doctors usefor the
radiography and radiotherapy), the visit was instructed by Eng. Adel
Manoun, he show us the main parts of the cyclotron, showed us how
everything works in details. The cyclotron that is used there is called
Siemens Eclipse Cyclotron.
Siemens Eclipse cyclotron, an 11 MeV negative ion single particle
accelerator, produces Curie levels of positron emitting radioisotopes 18F,
11C, 13N and 15O (in KHMC they use it only for 18F). Its self-shielded,
automated design offers you fast, easy, and efficient production of PET
radioisotopes. Eclipse cyclotrons meet a variety of needs from the fast
paced demands of the clinical environment, to flexible requirements for
research settings, to powerful performance for commercial distribution
centers.
14. 13
Figure [F]:Siemens Eclipse Cyclotron[2]
Figure [G]:Cyclotron without the shield[2]
The main parts of the cyclotron are:
1. The magnate system which provides the magnetic field that is required
to keep the ions on the center of the tank as in the right hand rule.
Figure [H]:The magnate system[2]
2. The vacuum system which responsible of making the perfect
environment for the acceleration of the ions inside the tank to reach the
desired speed. The responsible part for the vacuum is the diffusion pump
that produces up to 10-8 bar.
15. 14
Figure [I]:The vacuum system[2]
3. RF system (Radio Frequency system RF causes the ions to bunch up
into packets. Since the RF is pulsed and is present everywhere in the tank,
the ions all travel together like spokes on the wheel of a bicycle. This is
called isochronous motion.
Figure [J]:Radio Frequency system[2]
4. Ion source The RDS cyclotrons use a Penning Ion Gauge source,
known as a PIG, that sits vertically into the top of the main tank Ion
sourcecreates the negatively charged protons. Sourcesits in a very
specific location since the ions must be emitted in a precise location for
acceleration Sourcecan be steered automatically by software using
motors to align the beam. One DP is located directly underneath to
remove the hydrogen gas. Must be cleaned and rebuilt on a routine basis,
thus designed for easy insertion and removal.
16. 15
Figure [K]:Ion source[2]
The main use of the cyclotron is to produceFDG (fluoroduxiglucose)
which is a radioactive material that is used in PET scan, KHMC is the
main supplier of this material in Jordan and it cost10 JD for mci, and
they produceabout 500 mci a day which is more than enough to cover all
the hospitals in Jordan.
* Those pictures are provided by FNMS becauseKHMC is a military
facility where no cameras are allowed.
4.2 Luzmila Hospital (Jabal Al Weibdeh / St. Al
AradiWalMasaha / Amman – Jordan):
A visit that is supervised by Eng. Adel, Luzmila Hospital is a private
acute care and community health hospital that consists of 48 beds.
Founded in 1948.One of the oldest hospitals in Jordan providing
comprehensive health and medical service to the general public. The visit
17. 16
was to examine the CT angiogram (The latest technology of CT
angiogram form Siemens, that can perform cross sections or slices for the
main vessels in the body(Cerebral, Carotid, Pulmonary, Aorta,
Mesenteric and peripheral) within seconds, with a very high quality
images which makes the diagnosis more accurate.) and do it's calibrations
with the new printers the hospital just got. the cover was removed and the
x-ray sourcewas checked, the detector as well, the check was mainly for
the carbon brushes to make sure that they still functional and they were.
After the closing we went to controlroom and calibrated the device using
a phantom and then helped with the installed printers.
Figure [L]:CT angiogram[3]
4.3 Al-Basheer hospital (Amman - JabalAshrafieh -
Crown Street):
The visit was to service the linear accelerator, to calibrate the collimator
which is responsible for the collimation of the radiations that are directed
to patient, during our visit the problem was not dully solved there were
still a problem with the calibration. In the site the engineer showed as the
accelerator and how it works, he was very careful dealing with the
accelerator due to the radiations so he kept warning us about it to keep a
distance. This kind of machines is checked continuously because any
trouble with them can lead to a disaster.
18. 17
Figure [M]:The linear accelerator[3]
4.4 FNMS HQ (Amman – Al shmeisani) service of an US
machine:
There was no much work done on it, the problem was with a fuse so
when it was replaced the US operated as expected, but the engineer
taught us how so examine a medical device step by step, starting with the
power line check, then the cables, after that checking the power source,
when all of these things are cleared the boards will be checked to
determine the problem, with that test we also test the probes to see if they
work well because sometimes they cause a problem. The main problems
with the US are artifacts with the image concerning the resolution,
contrast, and the vagueness. As we learned many things can cause that
and every artifact is a lead to know the problem. We tried the device and
saw its function as the engineer checked the carotid artery and showed us
the modes of the device, every probehas a certain frequency that is used
to check certain area we also noticed that the deep we want to image the
lower frequency we use.
19. 18
Figure [N]:The US machine[3]
4.5 Jordan University Hospital (JUH) (Queen Rania Al
Abdullah Street - Amman):
JUH has a Siemens MRI machine, a routine check lead to patient table
calibration, we were not allowed to enter the MRI room so we were
located in the control room, so the calibration was done using the
computers and certain phantoms to act as a patient, as we were there the
engineer told us more about the MRI and about its troubles which are
usually caused by the operator or the technician with bad usage, since we
are dealing with MRI we dealing with a huge magnetic field, compressed
gas cylinders (He gas used in cooling), and heavy machine so there is
restricted safety rules when dealing with it.
20. 19
Figure [O]:MRI machine[3]
4.6 Arabic Medical Center :
Arabic medical center has an more than one seimens devices ; such that
CT- scan device ‗Sensation 64‘ , Ultra Sound , and Mamography Device
, in this visit we checked both of CT and Mamography devices , as usualy
we checked the carbonbruches of CT-scanand it was good , and
mamography device was perfect too .
Figure [P]:CT- scan device[3]
Conclusion
The training was extremely useful ; it helped me to make a connection
with what I had taken in classrooms with the real world, and became
famieler with siemens medical imaging devices .
I have learned so many thing related to the medical devices, I went deep
in their function, how they work, their effects on patients, operators and
21. 20
environment, the engineers were very generous to give us so many
information from their own experience which was helpful and useful.
The training mainly was about imaging medical devices which all are
heavy duty, expensive devices, needs so much knowledge to deal with,
the training didn't include small devices such as reparatory devices,
patient monitors, ECG and laboratory devices, but even if they weren't
mentioned we saw them in the hospitals we went to and we deal with it ,
since we have learned about them seeing them was helpful.
As a trainee, FNMS has a very helpful training program, the engineers
were very cooperative and experienced and they was helpful persons, the
visits were organized an a plan and useful, it was an unforgettable
experience that has a great effect in me as a biomedical engineer .
