{"ID":78184,"post_author":"9208550","post_date":"2018-12-17 16:46:25","post_date_gmt":"0000-00-00 00:00:00","post_content":"","post_title":"Introduction to Medical Devices: Volume 1","post_excerpt":"","post_status":"draft","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"","to_ping":"","pinged":"","post_modified":"2018-12-17 16:46:25","post_modified_gmt":"2018-12-17 21:46:25","post_content_filtered":"","post_parent":0,"guid":"https:\/\/www.limsforum.com\/?post_type=ebook&p=78184","menu_order":0,"post_type":"ebook","post_mime_type":"","comment_count":"0","filter":"","_ebook_metadata":{"enabled":"on","private":"0","guid":"FD633C54-E350-42B2-AE99-5B1FF5DDCDBA","title":"Introduction to Medical Devices: Volume 1","subtitle":"","cover_theme":"nico_13","cover_image":"https:\/\/www.limsforum.com\/wp-content\/plugins\/rdp-ebook-builder\/pl\/cover.php?cover_style=nico_13&subtitle=&editor=Shawn+Douglas&title=Introduction+to+Medical+Devices%3A+Volume+1&title_image=https%3A%2F%2Fs3.limsforum.com%2Fwww.limsforum.com%2Fwp-content%2Fuploads%2FStetoskop.jpg&publisher=LabLynx+Press","editor":"Shawn Douglas","publisher":"LabLynx Press","author_id":"26","image_url":"","items":{"509a78b4fc5d0046b2bae625b2c376a6_type":"article","509a78b4fc5d0046b2bae625b2c376a6_title":"Staphylococcus epidermidis","509a78b4fc5d0046b2bae625b2c376a6_url":"https:\/\/www.limswiki.org\/index.php\/Staphylococcus_epidermidis","509a78b4fc5d0046b2bae625b2c376a6_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tStaphylococcus epidermidis\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\n\n\n\n\nStaphylococcus epidermidis\n\n\n\n\n\nScanning electron image of S. epidermidis.\n\n\n\n\n\n\n\nScientific classification\n\n\n\n\n\n\n\nDomain:\n\nBacteria\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nPhylum:\n\nFirmicutes\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nClass:\n\nBacilli\n\n\n\n\n\n\n\n\n\n\n\nOrder:\n\nBacillales\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nFamily:\n\nStaphylococcaceae\n\n\n\n\n\n\n\n\n\n\n\n\n\nGenus:\n\nStaphylococcus\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nSpecies:\n\nS. epidermidis\n\n\n\n\n\n\n\n\n\nBinomial name\n\n\nStaphylococcus epidermidis \r\n(Winslow & Winslow 1908)\r\nEvans 1916\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nSynonyms\n\n\n\nStaphylococcus albus Rosenbach 1884\n\n\n\n\nStaphylococcus epidermidis is a Gram-positive bacterium, and one of over 40 species belonging to the genus Staphylococcus.[1] It is part of the normal human flora, typically the skin flora, and less commonly the mucosal flora.[2] It is a facultative anaerobic bacteria. Although S. epidermidis is not usually pathogenic, patients with compromised immune systems are at risk of developing infection. These infections are generally hospital-acquired.[3] S. epidermidis is a particular concern for people with catheters or other surgical implants because it is known to form biofilms that grow on these devices.[4] Being part of the normal skin flora, S. epidermidis is a frequent contaminant of specimens sent to the diagnostic laboratory.[5]\n\n Staphylococcus epidermidis biofilm on titanium substrate\nContents \n\n1 Etymology \n2 Discovery \n3 Cellular morphology and biochemistry \n4 Virulence and antibiotic resistance \n5 Disease \n6 Identification \n7 See also \n8 Notes and references \n9 External links \n\n\nEtymology \n'Staphylococcus' - bunch of grape-like berries, 'epidermidis' - of the epidermis [6]\n\nDiscovery \nFriedrich Julius Rosenbach distinguished S. epidermidis from S. aureus in 1884, initially naming S. epidermidis as S. albus.[7] He chose aureus and albus since the bacteria formed yellow and white colonies, respectively.\n\nCellular morphology and biochemistry \n Staphylococcus epidermidis, 1000 magnification under bright field microscopy\nS. epidermidis is a very hardy microorganism, consisting of nonmotile, Gram-positive cocci, arranged in grape-like clusters. It forms white, raised, cohesive colonies about 1\u20132 mm in diameter after overnight incubation, and is not hemolytic on blood agar.[4] It is a catalase-positive,[8] coagulase-negative, facultative anaerobe that can grow by aerobic respiration or by fermentation. Some strains may not ferment.[9]\nBiochemical tests indicate this microorganism also carries out a weakly positive reaction to the nitrate reductase test. It is positive for urease production, is oxidase negative, and can use glucose, sucrose, and lactose to form acid products. In the presence of lactose, it will also produce gas. S. epidermidis does not possess the gelatinase enzyme, so it cannot hydrolyze gelatin.[citation needed ] It is sensitive to novobiocin, providing an important test to distinguish it from Staphylococcus saprophyticus, which is coagulase-negative, as well, but novobiocin-resistant.[3]\nSimilar to those of S. aureus, the cell walls of S. epidermidis have a transferrin-binding protein that helps the organism obtain iron from transferrin. The tetramers of a surface exposed protein, glyceraldehyde-3-phosphate dehydrogenase, are believed to bind to transferrin and remove its iron. Subsequent steps include iron being transferred to surface lipoproteins, then to transport proteins which carry the iron into the cell.[4]\n\nVirulence and antibiotic resistance \nThe ability to form biofilms on plastic devices is a major virulence factor for S. epidermidis. One probable cause is surface proteins that bind blood and extracellular matrix proteins.\nIt produces an extracellular material known as polysaccharide intercellular adhesin (PIA), which is made up of sulfated polysaccharides. It allows other bacteria to bind to the already existing biofilm, creating a multilayer biofilm.\nSuch biofilms decrease the metabolic activity of bacteria within them. This decreased metabolism, in combination with impaired diffusion of antibiotics, makes it difficult for antibiotics to effectively clear this type of infection.[4]\nS. epidermidis strains are often resistant to antibiotics, including rifamycin, fluoroquinolones, gentamicin, tetracycline, clindamycin, and sulfonamides.[10] Methicillin resistance is particularly widespread, with 75-90% of hospital isolates resistance to methicilin.[10] Resistant organisms are most commonly found in the intestine, but organisms living freely on the skin can also become resistant due to routine exposure to antibiotics secreted in sweat.\n\nDisease \n Staphylococcus epidermidis stained by safranin.(x1000)\nAs mentioned above, S. epidermidis causes biofilms to grow on plastic devices placed within the body.[11] This occurs most commonly on intravenous catheters and on medical prostheses.[12]\nInfection can also occur in dialysis patients or anyone with an implanted plastic device that may have been contaminated.\nIt also causes endocarditis, most often in patients with defective heart valves. In some other cases, sepsis can occur in hospital patients.[citation needed ]\nAntibiotics are largely ineffective in clearing biofilms. The most common treatment for these infections is to remove or replace the infected implant, though in all cases, prevention is ideal. The drug of choice is often vancomycin, to which rifampin or an aminoglycoside can be added.[citation needed ] Hand washing has been shown to reduce the spread of infection.\nPreliminary research also indicates S. epidermidis is universally found inside affected acne vulgaris pores, where Propionibacterium acnes is normally the sole resident.[13]\n\nIdentification \nThe normal practice of detecting S. epidermidis is by using appearance of colonies on selective media, bacterial morphology by light microscopy, catalase and slide coagulase testing. On the Baird-Parker agar with egg yolk supplement, colonies appear small and black. Increasingly, techniques such as quantitative PCR are being employed for the rapid detection and identification of Staphylococcus strains.[14][15] Normally, sensitivity to desferrioxamine can also be used to distinguish it from most other staphylococci, except in the case of Staphylococcus hominis, which is also sensitive.[16] In this case, the production of acid from trehalose by S. hominis can be used to tell the two species apart.\n\nSee also \nBiofilms\nMicrobiology\nStaphylococcus\nNotes and references \n\n\n^ Schleifer, K. H.; Kloos, W. E. (1975). \"Isolation and Characterization of Staphylococci from Human Skin I. Amended Descriptions of Staphylococcus epidermidis and Staphylococcus saprophyticus and Descriptions of Three New Species Staphylococcus cohnii, Staphylococcus haemolyticus, and Staphylococcus xylosus\". International Journal of Systematic Bacteriology. 25 (1): 50\u201361. doi:10.1099\/00207713-25-1-50. ISSN 0020-7713. \n\n^ Fey, P. D.; Olson, M. E. (2010). \"Current concepts in biofilm formation of Staphylococcus epidermidis\". Future Microbiology. 5 (6): 917\u2013933. doi:10.2217\/fmb.10.56. PMC 2903046 . \n\n^ a b Levinson, W. (2010). Review of Medical Microbiology and Immunology (11th ed.). pp. 94\u201399. \n\n^ a b c d Salyers, Abigail A. & Whitt, Dixie D. (2002). Bacterial Pathogenesis: A Molecular Approach, 2nd ed. Washington, D.C.: ASM Press. ISBN 1-55581-171-X. \n\n^ Queck SY & Otto M (2008). \"Staphylococcus epidermidis and other Coagulase-Negative Staphylococci\". Staphylococcus: Molecular Genetics. Caister Academic Press. ISBN 978-1-904455-29-5. \n\n^ http:\/\/www.vetbact.org\/vetbact\/?artid=205 \n\n^ Friedrich Julius Rosenbach at Who Named It? \n\n^ \"Todar's Online Textbook of Bacteriology: Staphylococcus aureus and Staphylococcal Disease\". Kenneth Todar, PhD. Retrieved Dec 7, 2013 . \n\n^ \"Bacteria Genomes - STAPHYLOCOCCUS EPIDERMIDIS\". Karyn's Genomes. EMBL-EBI. Retrieved December 23, 2011 . \n\n^ a b Otto M (August 2010). \"Staphylococcus epidermidis - the \"accidental\" pathogen\". Nature Reviews Microbiology. 7 (8): 555\u2013567. doi:10.1038\/nrmicro2182. PMC 2807625 . \n\n^ Otto M (2009), \"Staphylococcus epidermidis \u2014 the 'accidental' pathogen\", Nature Reviews Microbiology, 7 (8): 555\u2013567, doi:10.1038\/nrmicro2182, PMC 2807625 , PMID 19609257 \n\n^ Hedin G (1993), \"Staphylococcus epidermidis \u2014 hospital epidemiology and the detection of methicillin resistance\", Scandinavian Journal of Infectious Diseases Supplementum, Oslo Norway: Scandinavian University Press, 90: 1\u201359, PMID 8303217 \n\n^ Bek-Thomson, M.; et al. (2008). \"Acne is Not Associated with Yet-Uncultured Bacteria\". Journal of Clinical Microbiology. 46 (10): 3355\u20133360. doi:10.1128\/JCM.00799-08. PMC 2566126 . PMID 18716234. \n\n^ Francois P & Schrenzel J (2008). \"Rapid Diagnosis and Typing of Staphylococcus aureus\". Staphylococcus: Molecular Genetics. Caister Academic Press. ISBN 978-1-904455-29-5. \n\n^ Mackay IM (editor). (2007). Real-Time PCR in Microbiology: From Diagnosis to Characterization. Caister Academic Press. ISBN 978-1-904455-18-9. \n\n^ Antunes, Ana L\u00facia Souza; Secchi, Carina; Reiter, Keli Cristine; Perez, Leandro Reus Rodrigues; Freitas, Ana L\u00facia Peixoto De; D'azevedo, Pedro Alves (2008-01-01). \"Feasible identification of Staphylococcus epidermidis using desferrioxamine and fosfomycin disks\". APMIS. 116 (1): 16\u201320. doi:10.1111\/j.1600-0463.2008.00796.x. ISSN 1600-0463. \n\n\nExternal links \nType strain of Staphylococcus epidermidis at BacDive - the Bacterial Diversity Metadatabase\nTeruaki Nakatsuji et al.: A commensal strain of Staphylococcus epidermidis protects against skin neoplasia, in: Science Advances; 28th of Feb., 2018; Vol. 4, No. 2, DOI:10.1126\/sciadv.aao4502\nvte\nFirmicutes (low-G+C) Infectious diseases\nBacterial diseases: G+\nprimarily A00\u2013A79, 001\u2013041, 080\u2013109\nBacilliLactobacillales\r\n(Cat-)Streptococcus\u03b1optochin susceptible\nS. pneumoniae\nPneumococcal infection\noptochin resistant\nViridans streptococci: S. mitis\nS. mutans\nS. oralis\nS. sanguinis\nS. sobrinus\nmilleri group\n\u03b2A\nbacitracin susceptible: S. pyogenes\nGroup A streptococcal infection\nStreptococcal pharyngitis\nScarlet fever\nErysipelas\nRheumatic fever\nB\nbacitracin resistant, CAMP test+: S. agalactiae\nGroup B streptococcal infection\nungrouped\nStreptococcus iniae\nCutaneous Streptococcus iniae infection\n\u03b3\nD\nBEA+: Streptococcus bovis\nEnterococcus\nBEA+: Enterococcus faecalis\nUrinary tract infection\nEnterococcus faecium\nBacillales\r\n(Cat+)StaphylococcusCg+\nS. aureus\nStaphylococcal scalded skin syndrome\nToxic shock syndrome\nMRSA\nCg-\nnovobiocin susceptible\nS. epidermidis\nnovobiocin resistant\nS. saprophyticus\nBacillus\nBacillus anthracis\nAnthrax\nBacillus cereus\nFood poisoning\nListeria\nListeria monocytogenes\nListeriosis\nClostridiaClostridium (spore-forming)motile:\nClostridium difficile\nPseudomembranous colitis\nClostridium botulinum\nBotulism\nClostridium tetani\nTetanus\nnonmotile:\nClostridium perfringens\nGas gangrene\nClostridial necrotizing enteritis\nPeptostreptococcus (non-spore forming)\nPeptostreptococcus magnus\nMollicutesMycoplasmataceae\nUreaplasma urealyticum\nUreaplasma infection\nMycoplasma genitalium\nMycoplasma pneumoniae\nMycoplasma pneumonia\nAnaeroplasmatales\nErysipelothrix rhusiopathiae\nErysipeloid\n\n Biology portal \nTaxon identifiers\nWikidata: Q131915 \nWikispecies: Staphylococcus epidermidis \nBacDive: 14529 \nEoL: 975953 \nEPPO: STAPEP \nGBIF: 3227655 \niNaturalist: 356566 \nIRMNG: 10540350 \nITIS: 377 \nNCBI: 1282 \nNZOR: a3dfb255-a960-44df-bbef-6642126dd86a \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Staphylococcus_epidermidis\">https:\/\/www.limswiki.org\/index.php\/Staphylococcus_epidermidis<\/a>\n\t\t\t\t\tCategory: Science termsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal 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id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\"><i>Staphylococcus epidermidis<\/i><\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p class=\"mw-empty-elt\">\n<\/p>\n\n<p><i><b>Staphylococcus epidermidis<\/b><\/i> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gram-positive\" class=\"mw-redirect\" title=\"Gram-positive\" rel=\"external_link\" target=\"_blank\">Gram-positive<\/a> bacterium, and one of over 40 species belonging to the genus <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Staphylococcus\" title=\"Staphylococcus\" rel=\"external_link\" target=\"_blank\">Staphylococcus<\/a><\/i>.<sup id=\"rdp-ebb-cite_ref-SchleiferKloos1975_1-0\" class=\"reference\"><a href=\"#cite_note-SchleiferKloos1975-1\" rel=\"external_link\">[1]<\/a><\/sup> It is part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_flora\" class=\"mw-redirect\" title=\"Human flora\" rel=\"external_link\" target=\"_blank\">normal human flora<\/a>, typically the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin_flora\" title=\"Skin flora\" rel=\"external_link\" target=\"_blank\">skin flora<\/a>, and less commonly the mucosal flora.<sup id=\"rdp-ebb-cite_ref-FeyOlson2010_2-0\" class=\"reference\"><a href=\"#cite_note-FeyOlson2010-2\" rel=\"external_link\">[2]<\/a><\/sup> It is a facultative anaerobic bacteria. Although <i>S. epidermidis<\/i> is not usually pathogenic, patients with compromised <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immune_system\" title=\"Immune system\" rel=\"external_link\" target=\"_blank\">immune systems<\/a> are at risk of developing infection. These infections are generally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital-acquired_infection\" title=\"Hospital-acquired infection\" rel=\"external_link\" target=\"_blank\">hospital-acquired<\/a>.<sup id=\"rdp-ebb-cite_ref-Levinson,_W._2010_94\u201399_3-0\" class=\"reference\"><a href=\"#cite_note-Levinson,_W._2010_94\u201399-3\" rel=\"external_link\">[3]<\/a><\/sup> <i>S. epidermidis<\/i> is a particular concern for people with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheters\" class=\"mw-redirect\" title=\"Catheters\" rel=\"external_link\" target=\"_blank\">catheters<\/a> or other surgical implants because it is known to form <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biofilms\" class=\"mw-redirect\" title=\"Biofilms\" rel=\"external_link\" target=\"_blank\">biofilms<\/a> that grow on these devices.<sup id=\"rdp-ebb-cite_ref-Salyers_4-0\" class=\"reference\"><a href=\"#cite_note-Salyers-4\" rel=\"external_link\">[4]<\/a><\/sup> Being part of the normal skin flora, <i>S. epidermidis<\/i> is a frequent contaminant of specimens sent to the diagnostic laboratory.<sup id=\"rdp-ebb-cite_ref-Queck_5-0\" class=\"reference\"><a href=\"#cite_note-Queck-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Staphylococcus_epidermidis_biofilm_on_titanium_substrate.tif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/be\/Staphylococcus_epidermidis_biofilm_on_titanium_substrate.tif\/lossy-page1-220px-Staphylococcus_epidermidis_biofilm_on_titanium_substrate.tif.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Staphylococcus_epidermidis_biofilm_on_titanium_substrate.tif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Staphylococcus epidermidis biofilm on titanium substrate<\/div><\/div><\/div>\n\n<h2><span class=\"mw-headline\" id=\"Etymology\">Etymology<\/span><\/h2>\n<p>'Staphylococcus' - bunch of grape-like berries, 'epidermidis' - of the epidermis <sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Discovery\">Discovery<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Friedrich_Julius_Rosenbach\" title=\"Friedrich Julius Rosenbach\" rel=\"external_link\" target=\"_blank\">Friedrich Julius Rosenbach<\/a> distinguished <i>S. epidermidis<\/i> from <i>S. aureus<\/i> in 1884, initially naming <i>S. epidermidis<\/i> as <i>S. albus<\/i>.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> He chose <i>aureus<\/i> and <i>albus<\/i> since the bacteria formed yellow and white colonies, respectively.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Cellular_morphology_and_biochemistry\">Cellular morphology and biochemistry<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Staphylococcus_epidermids.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/95\/Staphylococcus_epidermids.jpg\/220px-Staphylococcus_epidermids.jpg\" width=\"220\" height=\"162\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Staphylococcus_epidermids.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><i>Staphylococcus epidermidis<\/i>, 1000 magnification under bright field microscopy<\/div><\/div><\/div>\n<p><i>S. epidermidis<\/i> is a very hardy microorganism, consisting of nonmotile, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gram-positive\" class=\"mw-redirect\" title=\"Gram-positive\" rel=\"external_link\" target=\"_blank\">Gram-positive<\/a> cocci, arranged in grape-like clusters. It forms white, raised, cohesive colonies about 1\u20132 mm in diameter after overnight incubation, and is not <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemolytic\" class=\"mw-redirect\" title=\"Hemolytic\" rel=\"external_link\" target=\"_blank\">hemolytic<\/a> on blood agar.<sup id=\"rdp-ebb-cite_ref-Salyers_4-1\" class=\"reference\"><a href=\"#cite_note-Salyers-4\" rel=\"external_link\">[4]<\/a><\/sup> It is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catalase\" title=\"Catalase\" rel=\"external_link\" target=\"_blank\">catalase<\/a>-positive,<sup id=\"rdp-ebb-cite_ref-Todar_8-0\" class=\"reference\"><a href=\"#cite_note-Todar-8\" rel=\"external_link\">[8]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulase\" title=\"Coagulase\" rel=\"external_link\" target=\"_blank\">coagulase<\/a>-negative, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Facultative_anaerobe\" class=\"mw-redirect\" title=\"Facultative anaerobe\" rel=\"external_link\" target=\"_blank\">facultative anaerobe<\/a> that can grow by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aerobic_respiration\" class=\"mw-redirect\" title=\"Aerobic respiration\" rel=\"external_link\" target=\"_blank\">aerobic respiration<\/a> or by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fermentation_(biochemistry)\" class=\"mw-redirect\" title=\"Fermentation (biochemistry)\" rel=\"external_link\" target=\"_blank\">fermentation<\/a>. Some strains may not ferment.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>Biochemical tests indicate this microorganism also carries out a weakly positive reaction to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nitrate_reductase_test\" title=\"Nitrate reductase test\" rel=\"external_link\" target=\"_blank\">nitrate reductase test<\/a>. It is positive for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urease\" title=\"Urease\" rel=\"external_link\" target=\"_blank\">urease<\/a> production, is oxidase negative, and can use glucose, sucrose, and lactose to form acid products. In the presence of lactose, it will also produce gas. <i>S. epidermidis<\/i> does not possess the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gelatinase\" title=\"Gelatinase\" rel=\"external_link\" target=\"_blank\">gelatinase<\/a> enzyme, so it cannot hydrolyze gelatin.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2013)\">citation needed<\/span><\/a><\/i>]<\/sup> It is sensitive to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Novobiocin\" title=\"Novobiocin\" rel=\"external_link\" target=\"_blank\">novobiocin<\/a>, providing an important test to distinguish it from <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Staphylococcus_saprophyticus\" title=\"Staphylococcus saprophyticus\" rel=\"external_link\" target=\"_blank\">Staphylococcus saprophyticus<\/a><\/i>, which is coagulase-negative, as well, but novobiocin-resistant.<sup id=\"rdp-ebb-cite_ref-Levinson,_W._2010_94\u201399_3-1\" class=\"reference\"><a href=\"#cite_note-Levinson,_W._2010_94\u201399-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>Similar to those of <i>S. aureus<\/i>, the cell walls of <i>S. epidermidis<\/i> have a transferrin-binding protein that helps the organism obtain iron from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transferrin\" title=\"Transferrin\" rel=\"external_link\" target=\"_blank\">transferrin<\/a>. The tetramers of a surface exposed protein, glyceraldehyde-3-phosphate dehydrogenase, are believed to bind to transferrin and remove its iron. Subsequent steps include iron being transferred to surface lipoproteins, then to transport proteins which carry the iron into the cell.<sup id=\"rdp-ebb-cite_ref-Salyers_4-2\" class=\"reference\"><a href=\"#cite_note-Salyers-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Virulence_and_antibiotic_resistance\">Virulence and antibiotic resistance<\/span><\/h2>\n<p>The ability to form <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biofilm\" title=\"Biofilm\" rel=\"external_link\" target=\"_blank\">biofilms<\/a> on plastic devices is a major virulence factor for <i>S. epidermidis<\/i>. One probable cause is surface proteins that bind blood and extracellular matrix proteins.\nIt produces an extracellular material known as polysaccharide intercellular adhesin (PIA), which is made up of sulfated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polysaccharide\" title=\"Polysaccharide\" rel=\"external_link\" target=\"_blank\">polysaccharides<\/a>. It allows other bacteria to bind to the already existing biofilm, creating a multilayer biofilm.\nSuch biofilms decrease the metabolic activity of bacteria within them. This decreased metabolism, in combination with impaired diffusion of antibiotics, makes it difficult for antibiotics to effectively clear this type of infection.<sup id=\"rdp-ebb-cite_ref-Salyers_4-3\" class=\"reference\"><a href=\"#cite_note-Salyers-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<i>S. epidermidis<\/i> strains are often resistant to antibiotics, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rifamycin\" title=\"Rifamycin\" rel=\"external_link\" target=\"_blank\">rifamycin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroquinolones\" class=\"mw-redirect\" title=\"Fluoroquinolones\" rel=\"external_link\" target=\"_blank\">fluoroquinolones<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gentamicin\" title=\"Gentamicin\" rel=\"external_link\" target=\"_blank\">gentamicin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tetracycline\" title=\"Tetracycline\" rel=\"external_link\" target=\"_blank\">tetracycline<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clindamycin\" title=\"Clindamycin\" rel=\"external_link\" target=\"_blank\">clindamycin<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sulfonamide\" title=\"Sulfonamide\" rel=\"external_link\" target=\"_blank\">sulfonamides<\/a>.<sup id=\"rdp-ebb-cite_ref-Otto_10-0\" class=\"reference\"><a href=\"#cite_note-Otto-10\" rel=\"external_link\">[10]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methicillin\" title=\"Methicillin\" rel=\"external_link\" target=\"_blank\">Methicillin<\/a> resistance is particularly widespread, with 75-90% of hospital isolates resistance to methicilin.<sup id=\"rdp-ebb-cite_ref-Otto_10-1\" class=\"reference\"><a href=\"#cite_note-Otto-10\" rel=\"external_link\">[10]<\/a><\/sup> Resistant organisms are most commonly found in the intestine, but organisms living freely on the skin can also become resistant due to routine exposure to antibiotics secreted in sweat.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Disease\">Disease<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stained_Staphylococcus_epidermidis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/30\/Stained_Staphylococcus_epidermidis.jpg\/220px-Stained_Staphylococcus_epidermidis.jpg\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Stained_Staphylococcus_epidermidis.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><i>Staphylococcus epidermidis<\/i> stained by safranin.(x1000)<\/div><\/div><\/div>\n<p>As mentioned above, <i>S. epidermidis<\/i> causes biofilms to grow on plastic devices placed within the body.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> This occurs most commonly on intravenous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheters<\/a> and on medical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostheses\" class=\"mw-redirect\" title=\"Prostheses\" rel=\"external_link\" target=\"_blank\">prostheses<\/a>.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\nInfection can also occur in dialysis patients or anyone with an implanted plastic device that may have been contaminated.\nIt also causes <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endocarditis\" title=\"Endocarditis\" rel=\"external_link\" target=\"_blank\">endocarditis<\/a>, most often in patients with defective heart valves. In some other cases, sepsis can occur in hospital patients.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Antibiotics are largely ineffective in clearing biofilms. The most common treatment for these infections is to remove or replace the infected implant, though in all cases, prevention is ideal. The drug of choice is often <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vancomycin\" title=\"Vancomycin\" rel=\"external_link\" target=\"_blank\">vancomycin<\/a>, to which <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rifampin\" class=\"mw-redirect\" title=\"Rifampin\" rel=\"external_link\" target=\"_blank\">rifampin<\/a> or an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aminoglycoside\" title=\"Aminoglycoside\" rel=\"external_link\" target=\"_blank\">aminoglycoside<\/a> can be added.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (July 2011)\">citation needed<\/span><\/a><\/i>]<\/sup> Hand washing has been shown to reduce the spread of infection.\n<\/p><p>Preliminary research also indicates <i>S. epidermidis<\/i> is universally found inside affected <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acne_vulgaris\" class=\"mw-redirect\" title=\"Acne vulgaris\" rel=\"external_link\" target=\"_blank\">acne vulgaris<\/a> pores, where <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Propionibacterium_acnes\" class=\"mw-redirect\" title=\"Propionibacterium acnes\" rel=\"external_link\" target=\"_blank\">Propionibacterium acnes<\/a><\/i> is normally the sole resident.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Identification\">Identification<\/span><\/h2>\n<p>The normal practice of detecting <i>S. epidermidis<\/i> is by using appearance of colonies on selective media, bacterial morphology by light microscopy, catalase and slide coagulase testing. On the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Baird-Parker_agar\" title=\"Baird-Parker agar\" rel=\"external_link\" target=\"_blank\">Baird-Parker agar<\/a> with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Egg_yolk\" class=\"mw-redirect\" title=\"Egg yolk\" rel=\"external_link\" target=\"_blank\">egg yolk<\/a> supplement, colonies appear small and black. Increasingly, techniques such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quantitative_PCR\" class=\"mw-redirect\" title=\"Quantitative PCR\" rel=\"external_link\" target=\"_blank\">quantitative PCR<\/a> are being employed for the rapid detection and identification of <i>Staphylococcus<\/i> strains.<sup id=\"rdp-ebb-cite_ref-FrancoisP_14-0\" class=\"reference\"><a href=\"#cite_note-FrancoisP-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Mackay_15-0\" class=\"reference\"><a href=\"#cite_note-Mackay-15\" rel=\"external_link\">[15]<\/a><\/sup> Normally, sensitivity to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Desferrioxamine\" class=\"mw-redirect\" title=\"Desferrioxamine\" rel=\"external_link\" target=\"_blank\">desferrioxamine<\/a> can also be used to distinguish it from most other staphylococci, except in the case of <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Staphylococcus_hominis\" title=\"Staphylococcus hominis\" rel=\"external_link\" target=\"_blank\">Staphylococcus hominis<\/a><\/i>, which is also sensitive.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> In this case, the production of acid from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trehalose\" title=\"Trehalose\" rel=\"external_link\" target=\"_blank\">trehalose<\/a> by <i>S. hominis<\/i> can be used to tell the two species apart.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biofilms\" class=\"mw-redirect\" title=\"Biofilms\" rel=\"external_link\" target=\"_blank\">Biofilms<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Microbiology\" title=\"Microbiology\" rel=\"external_link\" target=\"_blank\">Microbiology<\/a><\/li>\n<li><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Staphylococcus\" title=\"Staphylococcus\" rel=\"external_link\" target=\"_blank\">Staphylococcus<\/a><\/i><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Notes_and_references\">Notes and references<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-SchleiferKloos1975-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SchleiferKloos1975_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Schleifer, K. H.; Kloos, W. E. (1975). \"Isolation and Characterization of Staphylococci from Human Skin I. Amended Descriptions of Staphylococcus epidermidis and Staphylococcus saprophyticus and Descriptions of Three New Species Staphylococcus cohnii, Staphylococcus haemolyticus, and Staphylococcus xylosus\". <i>International Journal of Systematic Bacteriology<\/i>. <b>25<\/b> (1): 50\u201361. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1099%2F00207713-25-1-50\" target=\"_blank\">10.1099\/00207713-25-1-50<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0020-7713\" target=\"_blank\">0020-7713<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Systematic+Bacteriology&rft.atitle=Isolation+and+Characterization+of+Staphylococci+from+Human+Skin+I.+Amended+Descriptions+of+Staphylococcus+epidermidis+and+Staphylococcus+saprophyticus+and+Descriptions+of+Three+New+Species+Staphylococcus+cohnii%2C+Staphylococcus+haemolyticus%2C+and+Staphylococcus+xylosus&rft.volume=25&rft.issue=1&rft.pages=50-61&rft.date=1975&rft_id=info%3Adoi%2F10.1099%2F00207713-25-1-50&rft.issn=0020-7713&rft.aulast=Schleifer&rft.aufirst=K.+H.&rft.au=Kloos%2C+W.+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-FeyOlson2010-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FeyOlson2010_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Fey, P. D.; Olson, M. E. (2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2903046\" target=\"_blank\">\"Current concepts in biofilm formation of Staphylococcus epidermidis\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Future_Microbiology\" title=\"Future Microbiology\" rel=\"external_link\" target=\"_blank\">Future Microbiology<\/a><\/i>. <b>5<\/b> (6): 917\u2013933. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2217%2Ffmb.10.56\" target=\"_blank\">10.2217\/fmb.10.56<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2903046\" target=\"_blank\">2903046<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Future+Microbiology&rft.atitle=Current+concepts+in+biofilm+formation+of+Staphylococcus+epidermidis&rft.volume=5&rft.issue=6&rft.pages=917-933&rft.date=2010&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2903046&rft_id=info%3Adoi%2F10.2217%2Ffmb.10.56&rft.aulast=Fey&rft.aufirst=P.+D.&rft.au=Olson%2C+M.+E.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2903046&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Levinson,_W._2010_94\u201399-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Levinson,_W._2010_94\u201399_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Levinson,_W._2010_94\u201399_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Levinson, W. (2010). <i>Review of Medical Microbiology and Immunology<\/i> (11th ed.). pp. 94\u201399.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Review+of+Medical+Microbiology+and+Immunology&rft.pages=94-99&rft.edition=11th&rft.date=2010&rft.au=Levinson%2C+W.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Salyers-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Salyers_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Salyers_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Salyers_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Salyers_4-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Salyers, Abigail A. & Whitt, Dixie D. (2002). <i>Bacterial Pathogenesis: A Molecular Approach, 2nd ed<\/i>. Washington, D.C.: ASM Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-55581-171-X.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Bacterial+Pathogenesis%3A+A+Molecular+Approach%2C+2nd+ed.&rft.place=Washington%2C+D.C.&rft.pub=ASM+Press&rft.date=2002&rft.isbn=1-55581-171-X&rft.au=Salyers%2C+Abigail+A.&rft.au=Whitt%2C+Dixie+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Queck-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Queck_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Queck SY & Otto M (2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.horizonpress.com\/staph\" target=\"_blank\">\"Staphylococcus epidermidis and other Coagulase-Negative Staphylococci\"<\/a>. <i>Staphylococcus: Molecular Genetics<\/i>. Caister Academic Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-904455-29-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Staphylococcus+epidermidis+and+other+Coagulase-Negative+Staphylococci&rft.btitle=Staphylococcus%3A+Molecular+Genetics&rft.pub=Caister+Academic+Press&rft.date=2008&rft.isbn=978-1-904455-29-5&rft.aulast=Queck&rft.aufirst=SY&rft.au=Otto%2C+M&rft_id=http%3A%2F%2Fwww.horizonpress.com%2Fstaph&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.vetbact.org\/vetbact\/?artid=205\" target=\"_blank\">http:\/\/www.vetbact.org\/vetbact\/?artid=205<\/a><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.whonamedit.com\/doctor.cfm\/1203.html\" target=\"_blank\">Friedrich Julius Rosenbach<\/a><\/i> at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Who_Named_It%3F\" class=\"mw-redirect\" title=\"Who Named It?\" rel=\"external_link\" target=\"_blank\">Who Named It?<\/a><\/span>\n<\/li>\n<li id=\"cite_note-Todar-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Todar_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/textbookofbacteriology.net\/staph.html\" target=\"_blank\">\"Todar's Online Textbook of Bacteriology: Staphylococcus aureus and Staphylococcal Disease\"<\/a>. Kenneth Todar, PhD<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">Dec 7,<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Todar%27s+Online+Textbook+of+Bacteriology%3A+Staphylococcus+aureus+and+Staphylococcal+Disease&rft.pub=Kenneth+Todar%2C+PhD&rft_id=http%3A%2F%2Ftextbookofbacteriology.net%2Fstaph.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ebi.ac.uk\/2can\/genomes\/bacteria\/Staphylococcus_epidermidis.html\" target=\"_blank\">\"Bacteria Genomes - STAPHYLOCOCCUS EPIDERMIDIS\"<\/a>. <i>Karyn's Genomes<\/i>. EMBL-EBI<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">December 23,<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Karyn%27s+Genomes.&rft.atitle=Bacteria+Genomes+-+STAPHYLOCOCCUS+EPIDERMIDIS&rft_id=http%3A%2F%2Fwww.ebi.ac.uk%2F2can%2Fgenomes%2Fbacteria%2FStaphylococcus_epidermidis.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Otto-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Otto_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Otto_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Otto M (August 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2807625\" target=\"_blank\">\"<i>Staphylococcus epidermidis<\/i> - the \"accidental\" pathogen\"<\/a>. <i>Nature Reviews Microbiology<\/i>. <b>7<\/b> (8): 555\u2013567. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnrmicro2182\" target=\"_blank\">10.1038\/nrmicro2182<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2807625\" target=\"_blank\">2807625<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Reviews+Microbiology&rft.atitle=Staphylococcus+epidermidis+-+the+%22accidental%22+pathogen&rft.volume=7&rft.issue=8&rft.pages=555-567&rft.date=2010-08&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2807625&rft_id=info%3Adoi%2F10.1038%2Fnrmicro2182&rft.au=Otto+M&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2807625&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFOtto_M2009\" class=\"citation\">Otto M (2009), \"Staphylococcus epidermidis \u2014 the 'accidental' pathogen\", <i>Nature Reviews Microbiology<\/i>, <b>7<\/b> (8): 555\u2013567, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnrmicro2182\" target=\"_blank\">10.1038\/nrmicro2182<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2807625\" target=\"_blank\">2807625<\/a><\/span>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19609257\" target=\"_blank\">19609257<\/a><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Reviews+Microbiology&rft.atitle=Staphylococcus+epidermidis+%E2%80%94+the+%27accidental%27+pathogen&rft.volume=7&rft.issue=8&rft.pages=555-567&rft.date=2009&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2807625&rft_id=info%3Apmid%2F19609257&rft_id=info%3Adoi%2F10.1038%2Fnrmicro2182&rft.au=Otto+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFHedin_G1993\" class=\"citation\">Hedin G (1993), \"Staphylococcus epidermidis \u2014 hospital epidemiology and the detection of methicillin resistance\", <i>Scandinavian Journal of Infectious Diseases Supplementum<\/i>, Oslo Norway: Scandinavian University Press, <b>90<\/b>: 1\u201359, <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8303217\" target=\"_blank\">8303217<\/a><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Scandinavian+Journal+of+Infectious+Diseases+Supplementum&rft.atitle=Staphylococcus+epidermidis+%E2%80%94+hospital+epidemiology+and+the+detection+of+methicillin+resistance&rft.volume=90&rft.pages=1-59&rft.date=1993&rft_id=info%3Apmid%2F8303217&rft.au=Hedin+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bek-Thomson, M.; et al. (2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2566126\" target=\"_blank\">\"Acne is Not Associated with Yet-Uncultured Bacteria\"<\/a>. <i>Journal of Clinical Microbiology<\/i>. <b>46<\/b> (10): 3355\u20133360. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1128%2FJCM.00799-08\" target=\"_blank\">10.1128\/JCM.00799-08<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2566126\" target=\"_blank\">2566126<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18716234\" target=\"_blank\">18716234<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Clinical+Microbiology&rft.atitle=Acne+is+Not+Associated+with+Yet-Uncultured+Bacteria&rft.volume=46&rft.issue=10&rft.pages=3355-3360&rft.date=2008&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2566126&rft_id=info%3Apmid%2F18716234&rft_id=info%3Adoi%2F10.1128%2FJCM.00799-08&rft.au=Bek-Thomson%2C+M.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2566126&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FrancoisP-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FrancoisP_14-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Francois P & Schrenzel J (2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.horizonpress.com\/staph\" target=\"_blank\">\"Rapid Diagnosis and Typing of Staphylococcus aureus\"<\/a>. <i>Staphylococcus: Molecular Genetics<\/i>. Caister Academic Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-904455-29-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Rapid+Diagnosis+and+Typing+of+Staphylococcus+aureus&rft.btitle=Staphylococcus%3A+Molecular+Genetics&rft.pub=Caister+Academic+Press&rft.date=2008&rft.isbn=978-1-904455-29-5&rft.aulast=Francois&rft.aufirst=P&rft.au=Schrenzel%2C+J&rft_id=http%3A%2F%2Fwww.horizonpress.com%2Fstaph&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Mackay-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Mackay_15-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Mackay IM (editor). (2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.horizonpress.com\/rtmic\" target=\"_blank\"><i>Real-Time PCR in Microbiology: From Diagnosis to Characterization<\/i><\/a>. Caister Academic Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-904455-18-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Real-Time+PCR+in+Microbiology%3A+From+Diagnosis+to+Characterization&rft.pub=Caister+Academic+Press&rft.date=2007&rft.isbn=978-1-904455-18-9&rft.au=Mackay+IM+%28editor%29.&rft_id=http%3A%2F%2Fwww.horizonpress.com%2Frtmic&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Antunes, Ana L\u00facia Souza; Secchi, Carina; Reiter, Keli Cristine; Perez, Leandro Reus Rodrigues; Freitas, Ana L\u00facia Peixoto De; D'azevedo, Pedro Alves (2008-01-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1600-0463.2008.00796.x\/abstract\" target=\"_blank\">\"Feasible identification of Staphylococcus epidermidis using desferrioxamine and fosfomycin disks\"<\/a>. <i>APMIS<\/i>. <b>116<\/b> (1): 16\u201320. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1600-0463.2008.00796.x\" target=\"_blank\">10.1111\/j.1600-0463.2008.00796.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1600-0463\" target=\"_blank\">1600-0463<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=APMIS&rft.atitle=Feasible+identification+of+Staphylococcus+epidermidis+using+desferrioxamine+and+fosfomycin+disks&rft.volume=116&rft.issue=1&rft.pages=16-20&rft.date=2008-01-01&rft_id=info%3Adoi%2F10.1111%2Fj.1600-0463.2008.00796.x&rft.issn=1600-0463&rft.aulast=Antunes&rft.aufirst=Ana+L%C3%BAcia+Souza&rft.au=Secchi%2C+Carina&rft.au=Reiter%2C+Keli+Cristine&rft.au=Perez%2C+Leandro+Reus+Rodrigues&rft.au=Freitas%2C+Ana+L%C3%BAcia+Peixoto+De&rft.au=D%27azevedo%2C+Pedro+Alves&rft_id=http%3A%2F%2Fonlinelibrary.wiley.com%2Fdoi%2F10.1111%2Fj.1600-0463.2008.00796.x%2Fabstract&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStaphylococcus+epidermidis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bacdive.dsmz.de\/index.php?search=14529&submit=Search\" target=\"_blank\">Type strain of <i>Staphylococcus epidermidis<\/i> at Bac<i>Dive<\/i> - the Bacterial Diversity Metadatabase<\/a><\/li>\n<li>Teruaki Nakatsuji et al.: <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/advances.sciencemag.org\/content\/4\/2\/eaao4502\" target=\"_blank\">A commensal strain of Staphylococcus epidermidis protects against skin neoplasia<\/a>, in: Science Advances; 28th of Feb., 2018; Vol. 4, No. 2, <a href=\"https:\/\/doi.org\/10.1126\/sciadv.aao4502\" class=\"extiw\" title=\"doi:10.1126\/sciadv.aao4502\" rel=\"external_link\" target=\"_blank\">DOI:10.1126\/sciadv.aao4502<\/a><\/li><\/ul>\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1325\nCached time: 20181216234105\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.556 seconds\nReal time usage: 0.684 seconds\nPreprocessor visited node count: 4512\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 131979\/2097152 bytes\nTemplate argument size: 4268\/2097152 bytes\nHighest expansion depth: 24\/40\nExpensive parser function count: 14\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 41981\/5000000 bytes\nNumber of Wikibase entities loaded: 13\/400\nLua time usage: 0.297\/10.000 seconds\nLua memory usage: 5.64 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 570.947 1 -total\n<\/p>\n<pre>35.03% 199.981 1 Template:Reflist\n27.33% 156.051 1 Template:Taxobox\n25.24% 144.119 1 Template:Taxobox\/core\n20.88% 119.232 5 Template:Cite_journal\n20.16% 115.115 11 Template:Navbox\n12.89% 73.620 1 Template:Taxonbar\n12.61% 71.976 14 Template:Delink\n11.46% 65.443 11 Template:Taxobox_colour\n 9.75% 55.648 1 Template:Gram-positive_bacterial_diseases\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2648919-1!canonical and timestamp 20181216234104 and revision id 873445757\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Staphylococcus_epidermidis\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214715\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.043 seconds\nReal time usage: 0.243 seconds\nPreprocessor visited node count: 25\/1000000\nPreprocessor generated node count: 139\/1000000\nPost\u2010expand include size: 127\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 5\/40\nExpensive parser function count: 0\/100\nLua time usage: 0.020\/7.000 seconds\nLua virtual size: 8.2 MB\/50 MB\nLua estimated memory usage: 0 bytes\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 230.591 1 - -total\n 64.63% 149.024 1 - wikipedia:Staphylococcus_epidermidis\n 34.98% 80.668 1 - Template:Italic_title\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8433-0!*!*!*!*!*!* and timestamp 20181217214715 and revision id 24675\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Staphylococcus_epidermidis\">https:\/\/www.limswiki.org\/index.php\/Staphylococcus_epidermidis<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","509a78b4fc5d0046b2bae625b2c376a6_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/Staphylococcus_epidermidis_01.png\/440px-Staphylococcus_epidermidis_01.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/be\/Staphylococcus_epidermidis_biofilm_on_titanium_substrate.tif\/lossy-page1-440px-Staphylococcus_epidermidis_biofilm_on_titanium_substrate.tif.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/95\/Staphylococcus_epidermids.jpg\/440px-Staphylococcus_epidermids.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/30\/Stained_Staphylococcus_epidermidis.jpg\/440px-Stained_Staphylococcus_epidermidis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2d\/Issoria_lathonia.jpg\/48px-Issoria_lathonia.jpg"],"509a78b4fc5d0046b2bae625b2c376a6_timestamp":1545083235,"c9e7e589abaded1dc205bee7420521de_type":"article","c9e7e589abaded1dc205bee7420521de_title":"Single-use medical device reprocessing","c9e7e589abaded1dc205bee7420521de_url":"https:\/\/www.limswiki.org\/index.php\/Single-use_medical_device_reprocessing","c9e7e589abaded1dc205bee7420521de_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSingle-use medical device reprocessing\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is an orphan, as no other articles link to it. Please introduce links to this page from related articles ; try the Find link tool for suggestions. (July 2014)\nSingle-use medical device reprocessing is the disinfection, cleaning, remanufacturing, testing, packaging and labeling, and sterilization among other steps, of a used, (or, in some cases, a device opened from its original packaging but unused), medical device to be put in service again. All reprocessed medical devices originally labeled for single use in the United States are subject to U.S. Food and Drug Administration (FDA) manufacturing requirements and must meet strict cleaning, functionality, and sterility specifications prior to use.[1] Although first regulated in the U.S., the reprocessing of medical devices, particularly those that are labeled \u201cSingle Use Device\u201d (SUDs), is a global practice with countries in Europe, Asia, Africa, and North America actively engaged in reprocessing.[2] Currently, approximately 2% of all SUDs on the U.S. market are eligible for reprocessing by a qualified third-party vendor.[3] The U.S. revenue for reprocessed devices (not SUDs) is estimated to be around $400 million annually.[4]\n\nContents \n\n1 History of reprocessing in the United States \n\n1.1 The Single Use Label \n\n\n2 Commonly reprocessed SUDs \n3 U.S. regulations for reprocessed SUDs \n4 Safety and efficacy of reprocessed SUDs \n5 Benefits of reprocessing \n\n5.1 Economic \n5.2 Environmental \n\n\n6 Physician and Clinical Statements in Support \n7 List of Known Regulated Third-Party SUD Reprocessing Vendors \n8 International Regulation of \u201cSingle-Use\u201d Medical Device Reprocessing \n\n8.1 European Union \n8.2 Africa and the Middle East \n\n8.2.1 Israel \n\n\n8.3 Asia\/Japan \n8.4 Australia \n8.5 Canada \n\n8.5.1 British Columbia \n8.5.2 Manitoba \n8.5.3 Alberta \n8.5.4 Northwest Territories \n8.5.5 Ontario \n8.5.6 Saskatchewan \n\n\n\n\n9 References \n\n\nHistory of reprocessing in the United States \nThe practice of reusing medical devices labeled for only one use began in hospitals in the late 1970s.[5] After a thorough review by the U.S. FDA in 1999 and 2000,[5] the agency released a guidance document for reprocessed SUDs that began regulating the sale of these reprocessed devices on the market,[6] under the condition that third-party reprocessors would be treated as the manufacturer and would meet the same criteria as the original equipment manufacturers (OEMs) of the medical device.[6] Following the implementation of FDA regulation, the U.S. Congress codified these standards and other requirements in the Medical Device User Fee Act of 2002.[7]\n\nThe Single Use Label \nOriginal equipment manufacturers undergo a thorough analysis to determine whether a device should be single-use or reusable. Factors in determining to label a device single-use include but are not limited to possible infection\/sterility concerns and the risk of reduced efficacy. Depending on the device and its design, failure to completely clean a single-use device could lead to cross patient infection or there is the risk that the chemicals used to clean the device will themselves pose a risk to patients by being absorbed, for example, by the plastic from which the device is made and then subsequently leaching out into a patient's body. There can also be the risk of deterioration of the device when exposed to cleaning or sterilization processes which could lead to device malfunction. When a manufacturer designs and develops a product, it determines the materials used and how the device is labeled.[8] In the U.S., to market a device as \u201creusable\u201d, a manufacturer must provide increased data requirements and invest the resources necessary to demonstrate to FDA that the product can be safely reprocessed at the hospital level.[9] Unlike reusable devices, single-use devices are not sold with instructions on how they can be properly cleaned and sterilized nor have they been validated or tested for exposure to cleaning or sterilization processes, including chemical exposure and heat.\n\nCommonly reprocessed SUDs \nCommonly reprocessed medical devices include lower-risk, U.S. FDA Class I non-invasive devices such as sequential compression sleeves, tourniquet cuffs, and pulse oximeter sensors, to medium-risk, FDA Class II minimally invasive surgical devices including Ear, Nose and Throat microdebriders and cautery electrodes, laparoscopic graspers, scissors, forceps, scalpels, orthopedic blades, bits, burs, external fixation clamps, bolts and components, and electrophysiological cardiac catheters.[10] To date, the FDA has not approved for reprocessing any Class III, or higher risk, SUDs.\n\nU.S. regulations for reprocessed SUDs \nThe Medical Device User Fee and Modernization Act of 2002 (MDUFMA), and Medical Device User Fee Stabilization Act of 2005 were signed into law on October 26, 2002, and August 1, 2005, respectively. All medical devices including reprocessed devices are subject to premarket review by the U.S. FDA, unless the agency has, by regulation, declared the device to be exempt from premarket requirements.[1] Unless exempt, the lower risk \u201cClass I\u201d and \u201cClass II\u201d devices, whether \u201coriginal\u201d or reprocessed, are required to have cleared premarket notification submissions (\u201c510(k)s\u201d).[11] With regard to premarket review, reprocessors are subject to more stringent regulation by FDA than are OEMs[12] because MDUFMA, require FDA to withdraw premarket notification exemptions for a significant number of previously exempt reprocessed devices, although \u201coriginal\u201d devices remain exempt from premarket review.[13]\nReprocessors must also validate the cleaning and sterilization methods they seek to use in the reprocessing of a SUD, and include in their 510(k) submissions \u201cvalidation data [...] regarding cleaning, sterilization, and functional performance\u201d to show that the reprocessed device \u201cwill remain substantially equivalent [...] after the maximum number of times the device is reprocessed as intended\u201d.[14] Both OEMs and reprocessors are subject to establishment registration and medical device listing; medical device reporting; medical device tracking; reports of corrections and removals, the quality system regulation (\u201cQSR\u201d); and labeling requirements.[6]\n\nSafety and efficacy of reprocessed SUDs \nFDA and the independent U.S. Government Accountability Office (GAO) have concluded that there is no evidence of harm to patients from FDA-regulated reprocessed SUDs. A 2008 GAO report found that of the over 320,000 adverse events filed with FDA between 2000 and 2006, only 65 adverse events \u201cactually involved or were suspected to involve a reprocessed SUD and that the reprocessed SUD was one of several possible causal factors in the adverse event. In reviewing these 65 reports, FDA found that the types of adverse events reported to be associated with the use of reprocessed SUDs were the same types of events that were reported for new devices\u201d.[15] The 2008 GAO report concluded: \u201cAfter reviewing the available evidence \u2013 including FDA\u2019s process for identifying and investigating device-related adverse events reported to involve reprocessed SUDs, peer-reviewed studies published since 2000, and the results of our and FDA\u2019s consultations with hospital representatives \u2013 we found no reason to question FDA\u2019s analysis indicating that no causative link has been established between reported injuries or deaths and reprocessed SUDs\".[15] In a separate letter from FDA to Congressman Tom Davis and Harry Waxman dated January 23, 2006, FDA indicated that a total of 65,325 reports have been filed between 2003 and 2006 for the malfunction or injury associated with the first use of devices labeled for \u201csingle use.\u201d The same search produced 176 cases of apparent malfunction or injury associated with reprocessed devices. Upon analysis of the latter reports, FDA determined that these adverse events were not related to the reprocessing of the \u201csingle use\u201d device.[16]\n\nBenefits of reprocessing \nEconomic \nFDA-regulated reprocessed devices cost between 40%-60% of an original device.[17] Currently, reprocessors estimate that a typical 200-bed hospital, if taking advantage of a reprocessor\u2019s full product line, can save between $600,000 and $1 million a year and divert between 5,000 and 15,000 pounds of waste from landfills.[18] According to a study by The Commonwealth Fund with funding from the Robert Wood Johnson Foundation and Health Care Without Harm in November 2012, they estimated that from hospitals implementing a reprocessing program, cost savings over five years was about $57 per procedure, and that if hospitals nationwide adopted an SUD reprocessing intervention, cost savings would be $540 million annually, or $2.7 billion over five years.[19]\n\nEnvironmental \nRegulated medical waste (RMW), or \u201cred bag waste,\u201d is a waste expenditure that typically costs hospitals 6 to 10 times more to dispose of than regular solid waste.[17] Among the inventory of devices reprocessed annually, ninety-five percent (95%) are recycled at the end of their life cycle rather than sent to landfills.[20] A variety of otherwise reprocessable raw materials that end up in a hospital\u2019s RMW include stainless steel, aluminum, titanium, gold, polycarbonate and polyurethane. Reprocessing has allowed some hospitals to divert over 8,000 pounds of RMW from landfills each year, while larger systems can divert more than 50,000 pounds.[21]\n\nPhysician and Clinical Statements in Support \nAmerican College of Cardiology (ACC) (1999)[22]\nAssociation for Healthcare Resource and Materials Management (AHRMM) Reprocessing Advisory [23]\nAmerican Hospital Association (AHA) (2000) [24]\nAmerican Medical Association (AMA), Report of the Council on Scientific Affairs (I-00) (2000) [25]\nAmerican Nursing Association (ANA), (2010)[26]\nAssociation of periOperative Registered Nurses (AORN), Environmental Responsibility (2006)[27]\nPractice Greenhealth [28]\nThe Mayo Clinic (with AAOS and AHA), August 2, 2001 [29]\nList of Known Regulated Third-Party SUD Reprocessing Vendors \n\n\nRegulated Vendor\nLocation\n\n\nHygia Health Services[30]\nBirmingham, AL\n\n\nMedline ReNewal[31]\nRedmond, OR\n\n\nNEScientific[32]\nWaterbury, CT\n\n\nReNu Medical[33]\nEverett, WA\n\n\nSterilMed, Inc[34]\nMaple Grove, MN\n\n\nSteriPro Canada, Inc[35]\nToronto, Canada\n\n\nStryker Sustainability Solutions[36]\nLakeland, FL\n\n\nSureTek Medical[37]\nGreenville, SC\n\n\nVanguard (International)[38]\nBerlin, Germany\n\n\nThe Association of Medical Device Reprocessors (AMDR),[39] based in Washington, D.C., is the global trade association consisting of members of the regulated, commercial single-use medical device reprocessing and remanufacturing industry. AMDR was founded in 1997 and the commercial single-use medical device reprocessors in the association now serve a majority of U.S. hospitals, including all the country\u2019s Honor Roll hospitals, as ranked by U.S. News & World Report.\"[40]\n\n International Regulation of \u201cSingle-Use\u201d Medical Device Reprocessing \nThe reprocessing of SUDs is commonplace worldwide. Even in developed nations, including those that have reprocessing prohibitions in place, hospitals routinely reuse SUDs in an unregulated manner. In many cases (particularly in Africa and Asia), uncontrolled reuse of such devices is relatively common, if not the norm.[41]\n\nEuropean Union \nCurrently, the European Union (EU) does not have a single policy regarding the reprocessing of SUDs. However, it is in the process of revising its Medical Device Directive. In 1993, at the issuance of the last Medical Device Directive, the issue of medical device reprocessing was identified as in need of additional clarification and the European Commission was instructed to submit a report on the issue by 2010.[42] In August, 2010, the Commission released its report,[43] highlighting the risks of unregulated reprocessing. Ultimately, the European Commission released its proposal[44] and the European Parliament approved its draft[45] (9 October 2013). Both legislative versions propose to regulate reprocessing as manufacturing. The European Council is now set to approve its own version of the legislation. Ultimately, both the Council and Parliament will have to agree, meeting in Trialogue with the European Commission, on the final version of the legislation. It is hoped the final agreement on the regulation will completed in 2015.\nUntil then, regulation of reprocessing activities is left to the individual Member States. Since 2001, Germany has had in place a regulatory framework that does not distinguish between the reprocessing of \u201creusable\u201d and so-called \u201csingle-use\u201d medical devices. The guidelines, therefore, allow for SUD reprocessing if conformance with certain standards is achieved. The German Medical Devices Law and the Medical Devices Operator Ordinance regulate the reprocessing of medical devices and in doing so refer to the mutual recommendation by the Robert Koch Institute (RKI) and the Federal Institute for Drugs and Medical Devices (BfArM) for the reprocessing of medical devices.[46] As a result, the RKI\u2019s requirements must be observed.\nInstitutions, which want to reprocess single-use medical devices, must adopt and implement a quality management system according to DIN EN ISO 13485:2007. Compliance with the quality management requirements is monitored annually by \u201cNotified Bodies\u201d that have been accredited by the Central Authority of the L\u00e4nder for Health Protection with regard to Medicinal Products and Medical Devices (ZLG).\nOther Member States, such as the United Kingdom, Spain and France,[47] discourage or prohibit SUD reprocessing. The majority of Member States in Europe do not have any national regulations regarding reprocessing.[48]\n\nAfrica and the Middle East \nThe lack of resources, including medical devices and distribution channels, \u201cnecessitates the reuse of single-use devices\u201d in much of Africa.[41] This includes the reuse of syringes and needles that have not been sterilized, and even rubber gloves. In the Middle East, available data indicates that reuse of SUDs is common throughout Arab countries (particularly for cardiac catheters), despite the absence of a regulatory framework. Reprocessing in both Africa and the Middle East is done at the user-facility level.[41]\n\nIsrael \nIsrael does not have regulations in place specific to the reprocessing of SUDs, but as a general matter, medical devices must be registered with the Ministry of Health (MOH) before they can be sold in the country. If a product is approved by the U.S. FDA, it will generally be registered by the MOH with no further testing requirements and, therefore, may be lawfully marketed in the country. Consistent with this policy, FDA-cleared reprocessed devices have been registered with MOH and are actively imported into the country.[49]\n\n Asia\/Japan \nThe reuse of SUDs in much of Asia is common, particularly for injection needles.[41] For the most part, there are no national regulations governing reuse of SUDs and, thus, third-party reprocessors do not offer their services in Asia. Rather, most reuse in Asia is conducted in an unregulated-manner at the user-facility level. Reprocessing is not currently regulated in Japan, but, available data indicates that the reuse of SUDs is relatively common. A 2003 survey found that 80 to 90 percent of hospitals reused SUDs.[41]\n\nAustralia \nAustralia enacted regulations regarding the reprocessing (\u201cremanufacturing\u201d in Australia) of SUDs in 2003.[50] Similar to the U.S., in Australia, all reprocessors (third-party, hospital, and OEM) must conform to medical device manufacturer requirements as regulated by the Therapeutic Goods Administration (TGA). Prior to implementation of these requirements, hospital reprocessing of SUDs was common.\n\nCanada \nHealth Canada does not currently regulate reprocessed single-use devices or the third-party companies that are reprocessing these devices for Canadian hospitals. Whether or not to reprocess a single-use device is determined by the territorial and provincial health ministries as well as hospital boards.[51] A number of provinces have adopted similar positions that allow for the reprocessing of SUDs if the third party reprocessor is regulated by the FDA.\n\nBritish Columbia \nBritish Columbia issued a policy to its health authorities stating that by January 1, 2008, all health authorities must have eliminated the reprocessing and reuse of critical contact SUDs, unless they have been reprocessed by a licensed third-party reprocessor that is certified by a national regulatory authority such as Health Canada or the U.S. Food and Drug Administration.[51] The policy was revised in 2011 with additional information that sharps (e.g. scalpel blades, drill bits, saw blades, shavers) and needles shall be single-use and shall not be reprocessed.\n\nManitoba \nManitoba does not permit hospitals to reuse SUDs in-house, but does permit hospitals to contract with an FDA regulated vendor, among other requirements.[52]\n\nAlberta \nAlberta Health Services issued a policy in 2012 prohibiting the reuse and reprocessing of both critical and semi-critical single-use medical devices.[53]\n\nNorthwest Territories \nSince 2005, the Northwest Territories have prohibited reprocessing. Specifically, the Northwest Territories Department of Health and Social Services revised its Hospital and Health Care Facility Standards Regulations to require that \u201ca disposable device intended to be used on a patient during a single procedure shall not be used on a patient for more than one procedure and shall not be used on another patient.\" [51]\n\nOntario \nIn 2006, the Ontario Ministry of Health and Long Term Care endorsed a guidance document developed by its Provincial Infectious Diseases Advisory Committee (PIDAC) advising that critical and semi-critical SUDs must not be reprocessed and reused, unless the reprocessing is done by a licensed reprocessor.[51]\n\nSaskatchewan \nIn 2013, The Saskatchewan Ministry of Health affirmed a policy outlining requirements for hospitals that reprocess SUDs. Consistent with the policies of other provinces, Saskatchewan requires, among other things, that hospitals outsource to an FDA regulated vendor.[54]\n\nReferences \n\n\n^ a b \"Reprocessing of Single-Use Devices\". Fda.gov. 2006-09-26. Retrieved 2013-10-24 . \n\n^ \"A Winning Approach | AMH Magazine - Preventing Infection in Medical Treatment\". AMH Magazine. Retrieved 2013-10-24 . \n\n^ Landro, Laura (2008-03-19). \"Hospitals Reuse Medical Devices To Lower Costs - WSJ.com\". Online.wsj.com. Retrieved 2013-10-24 . \n\n^ Rodak, Sabrina (2013-06-14). \"Reprocessing Saves Up to $20k Per OR Annually\". Beckersasc.com. Retrieved 2013-10-24 . \n\n^ a b \"Reuse of Medical Devices Labeled for Single-use\". Fda.gov. Retrieved 2013-10-24 . \n\n^ a b c \"Enforcement Priorities for Single-Use Devices Reprocessed by Third Parties and Hospitals\". Fda.gov. Retrieved 2013-10-24 . \n\n^ \"MDUFMA Frequently Asked Questions\". Fda.gov. Retrieved 2013-10-24 . \n\n^ Office, U. S. Government Accountability (2008-03-03). \"Reprocessed Single Use Devices: FDA Oversight Has Increased, and Available Information Does Not Indicate That Use Presents an Elevated Health Risk\" (GAO-08\u2013147). GAO-08-147: Published: Jan 31, 2008. Publicly Released: Mar 3, 2008. \n\n^ \"Draft Guidance for Industry and FDA Staff - Processing\/Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling\". Fda.gov. Retrieved 2013-10-24 . \n\n^ \"List of Single-Use Devices Known To Be Reprocessed or Considered for Reprocessing (Attachment 1)\". Fda.gov. Retrieved 2013-10-24 . \n\n^ \"List 2 - Reprocessed Single-Use Devices Subject to Premarket Notification Requirements That Now Require the Submission of Validation\". Fda.gov. Retrieved 2013-10-24 . \n\n^ Testimony of Dr. Daniel Schultz, Director, CDRH, FDA (September 26, 2006) (\"Congress mandated a number of new requirements for SUD reprocessors including, for certain SUDs, the pre-market submission of data to the agency that exceeded the requirements for the original manufacturers (OEMs)\" http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/ReprocessingofSingle-UseDevices\/ucm121067.htm \n\n^ \"Guidance for Industry and FDA Staff - Medical Device User Fee and Modernization Act of 2002, Validation Data in Premarket Notification Submissions (510(k)s) for Reprocessed Single-Use Medical Devices\". Fda.gov. Retrieved 2013-10-24 . \n\n^ \"68 Fed. Reg. 23139\" (PDF) . April 30, 2003. citing 21 U.S.C. \u00a7 360(o) (emphasis added). For a full description of the validation data reprocessors must submit on a premarket basis, including more particular guidance on cleaning, functional testing, and sterilization data requirements, see Guidance for Industry and FDA Staff: Medical Device User Fee and Modernization Act of 2002, Validation Data in Premarket Notification Submissions (510(k)s) for Reprocessed Medical Devices (Sept. 25, 2006), at 15 \n\n^ a b U.S. Government Accountability Office, GAO-08-147, Reprocessed Single-Use Medical Devices: FDA Oversight Has Increased, and Available Information Does Not Indicate That Use Presents an Elevated Health Risk (January 2008), at 1 http:\/\/www.gao.gov\/new.items\/d08147.pdf; See also, GAO\u2019s 2000 report: \n\n^ \"Letter from FDA to Congressman Tom Davis and Harry Waxman dated January 23, 2006\" (PDF) . Fda.gov. Retrieved 2013-10-24 . \n\n^ a b Sheehan, Kaeleigh. \"Reprocess and Reuse\". Greenhealth Magazine. Retrieved 2013-10-24 . \n\n^ \"Remanufactured Goods: An Overview\" (PDF) . Usitc.gov. Retrieved 2014-03-07 . \n\n^ SuSan Kaplan, Blair Sadler, Kevin little, Calvin Franz, and Peter OrrisS \"Can Sustainable Hospitals Help Bend the Health Care Cost Curve?\". The Commonwealth Fund. Retrieved 2013-10-24 . \n\n^ \"AMDR Statement\" (PDF) . Usitc.gov. Retrieved 2014-03-07 . \n\n^ \"Healthier Hospitals Initiative 2012 Milestone Report\" (PDF) . Healthierhosptials.org. Retrieved 2014-03-07 . \n\n^ \"Letter from American College of Cardiology to Senator Richard Durbin in support of reprocessing\" (PDF) . 1999. \n\n^ \"Reprocessing Advisory\". ahrmm.org. Retrieved 2014-03-30 . \n\n^ \"Letter from American Hospital Association to Senator Thad Cochran in support of reprocessing\" (PDF) . 1999. \n\n^ \"2000 Interim Meeting of the American Medical Association, Reports of the Council on Scientific Affairs\" (PDF) . \n\n^ \"American Nursing Association 2010 House of Delegates Resolution: Safety and Effectiveness of Reprocessed Single Use Devices in Healthcare\" (PDF) . 2010. \n\n^ (PDF) http:\/\/amdr.org\/documents\/APICsingleusedevicepositionChangesIncluded-Final8_31_07-r.pdf. Missing or empty |title= (help) \n\n^ \"Frequently Asked Questions | Practice Greenhealth\". practicegreenhealth.org. Retrieved 2014-03-30 . \n\n^ \"Letter from Mayo Clinic to Secretary Tommy Thompson, Department of Health and Human Services\" (PDF) . 2001. \n\n^ http:\/\/www.hygia.net\/ Official Website \n\n^ http:\/\/www.medlinerenewal.com\/ Official Website \n\n^ http:\/\/www.mdreprocess.com\/ Official Website \n\n^ http:\/\/renumedical.com\/ Official Website \n\n^ http:\/\/www.sterilmed.com\/ Official Website \n\n^ http:\/\/www.steriprocanada.com\/ Official Website \n\n^ http:\/\/sustainability.stryker.com\/ Official Website \n\n^ http:\/\/suretekmedical.com\/ Official Website \n\n^ http:\/\/www.vanguard-healthcare.com\/ Official Website \n\n^ \"Home\". AMDR home page. Retrieved 14 May 2018 . \n\n^ \"AMDR members are serving all of U.S. News & World Report's \"honor roll\" hospitals\". AMDR Top Hopsitals. 2017-09-19. Retrieved 14 May 2018 . \n\n^ a b c d e Popp, Walter; Rasslan, Ossama; Unahalekhaka, Akeau; Brenner, Pola; Fischnaller, Edith; Fathy, Maha; Goldman, Carol; Gillespie, Elizabeth (July 2010). \"What is the use? An international look at reuse of single-use medical devices\". International Journal of Hygiene and Environmental Health. 213 (4): 302\u2013307. doi:10.1016\/j.ijheh.2010.04.003. PMID 20471316. \n\n^ \"Council Directive 93\/42\/EEC (14 June 1993), Article 12a, OJ L 169, 12.7.1993, p. 1.\" \n\n^ \"Report from the Commission to the European Parliament and the Council: Report on the Issue of the Reprocessing of Medical Devices in the European Union, in Accordance with Article 12a of Directive 93\/42\/EEC, European Commission (27 August 2010).\" \n\n^ \"European Commission, Proposal for a REGULATION OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL, on medical devices, and amending Directive 2001\/83\/EC, Regulation (EC) No 178\/2002 and Regulation (EC) No 1223\/2009 (26 September 2012).\" \n\n^ \"European Parliament, Report on the proposal for a regulation of the European Parliament and of the Council on medical devices, and amending Directive 2001\/83\/EC, Regulation (EC) No 178\/2002 and Regulation (EC) No 1223\/2009 (COM(2012)0542 \u2013 C7-0318\/2012 \u2013 2012\/0266(COD)), Committee on the Environment, Public Health and Food Safety (9 October 2013).\" \n\n^ \"Hygienic Requirements for Processing of Medical Devices: Recommendation by the Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute (RKI) and the Federal German Institute for Medical Drugs and Medical Products (BfArM) Concerning the \"Hygienic Requirements for Processing of Medical Devices,\" Robert Koch Institute: Recommendation (2001).\" \n\n^ Commission Report, supra note 2, at 6. See also, Circulaire DGS\/DH n 51 (December 29, 1994) Relative a l\u2019utilisation des dispositifs medicaux steriles a usage unique dans les etblissements de sant\u00e9 publics et prives (France), Ministerio de sanidad y consume, Royal Decree 414.1996 Sec. 5, (July 9, 1999) (Spain) and MHRA Device Bulletin: DB 2006(04) Single-Use Medical Devices: Implications and Consequences of Reuse (UK).\" \n\n^ Commission Report, supra note 2, at 6. See also, European Association of Medical Device Reprocessors.\" \n\n^ \"Medical Device Regulatory Requirements for Israel,\", U.S. International Trade Administration (May 2, 2005) http:\/\/www.ita.doc.gov\/td\/health\/israelregs.html \n\n^ \"Statement by the TGA on regulations for sterilisation of single use devices,\" Australian Government, Therapeutic Goods Administration (July 21, 2003) http:\/\/www.tga.gov.au\/archive\/media-2003-sud-030721.htm \n\n^ a b c d CADTH Report \"Issue Analysis Summary: The Reuse of Single-Use Medical Devices,\" Health Canada; Therapeutic Products Directorate (April 28, 2005) http:\/\/www.hc-sc.gc.ca\/dhp-mps\/alt_formats\/hpfb-dgpsa\/pdf\/md-im\/saprmd_ias_gcsrmm_raq_2005-06-09-eng.pdf. See also, \"Reprocessing Single-Use Medical Devices: An Update of the Clinical Evidence and An Environmental Scan of Policies in Canada,\" Canadian Agency for Drugs and Technologies in Health (June 23, 2010) http:\/\/www.cadth.ca\/media\/pdf\/ES8_Reprocessing_SUDs_e.pdf \n\n^ Manitoba Deputy Health Minister\u2019s Office (March 21, 2013) \n\n^ Alberta Health Services. Single Use Medical Devices Policy. May 1, 2012 http:\/\/www.albertahealthservices.ca\/6444.asp \n\n^ Saskatchewan Health, Deputy Minister\u2019s Office (June 27, 2013) \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Single-use_medical_device_reprocessing\">https:\/\/www.limswiki.org\/index.php\/Single-use_medical_device_reprocessing<\/a>\n\t\t\t\t\tCategories: Healthcare termsRegulation of medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 21:17.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,328 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","c9e7e589abaded1dc205bee7420521de_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Single-use_medical_device_reprocessing skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Single-use medical device reprocessing<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Single-use medical device reprocessing<\/b> is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disinfection\" class=\"mw-redirect\" title=\"Disinfection\" rel=\"external_link\" target=\"_blank\">disinfection<\/a>, cleaning, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Remanufacturing\" title=\"Remanufacturing\" rel=\"external_link\" target=\"_blank\">remanufacturing<\/a>, testing, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Packaging_and_labeling\" title=\"Packaging and labeling\" rel=\"external_link\" target=\"_blank\">packaging and labeling<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">sterilization<\/a> among other steps, of a used, (or, in some cases, a device opened from its original packaging but unused), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> to be put in service again. All reprocessed medical devices originally labeled for single use in the United States are subject to <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._Food_and_Drug_Administration\" class=\"mw-redirect\" title=\"U.S. Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">U.S. Food and Drug Administration<\/a> (FDA) manufacturing requirements and must meet strict cleaning, functionality, and sterility specifications prior to use.<sup id=\"rdp-ebb-cite_ref-fda_a_1-0\" class=\"reference\"><a href=\"#cite_note-fda_a-1\" rel=\"external_link\">[1]<\/a><\/sup> Although first regulated in the U.S., the reprocessing of medical devices, particularly those that are labeled \u201cSingle Use Device\u201d (SUDs), is a global practice with countries in Europe, Asia, Africa, and North America actively engaged in reprocessing.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> Currently, approximately 2% of all SUDs on the U.S. market are eligible for reprocessing by a qualified third-party <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vendor\" title=\"Vendor\" rel=\"external_link\" target=\"_blank\">vendor<\/a>.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> The U.S. revenue for reprocessed devices (not SUDs) is estimated to be around $400 million annually.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History_of_reprocessing_in_the_United_States\">History of reprocessing in the United States<\/span><\/h2>\n<p>The practice of reusing medical devices labeled for only one use began in hospitals in the late 1970s.<sup id=\"rdp-ebb-cite_ref-fda_5-0\" class=\"reference\"><a href=\"#cite_note-fda-5\" rel=\"external_link\">[5]<\/a><\/sup> After a thorough review by the U.S. FDA in 1999 and 2000,<sup id=\"rdp-ebb-cite_ref-fda_5-1\" class=\"reference\"><a href=\"#cite_note-fda-5\" rel=\"external_link\">[5]<\/a><\/sup> the agency released a guidance document for reprocessed SUDs that began regulating the sale of these reprocessed devices on the market,<sup id=\"rdp-ebb-cite_ref-Fda.gov_6-0\" class=\"reference\"><a href=\"#cite_note-Fda.gov-6\" rel=\"external_link\">[6]<\/a><\/sup> under the condition that third-party reprocessors would be treated as the manufacturer and would meet the same criteria as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Original_equipment_manufacturers\" class=\"mw-redirect\" title=\"Original equipment manufacturers\" rel=\"external_link\" target=\"_blank\">original equipment manufacturers<\/a> (OEMs) of the medical device.<sup id=\"rdp-ebb-cite_ref-Fda.gov_6-1\" class=\"reference\"><a href=\"#cite_note-Fda.gov-6\" rel=\"external_link\">[6]<\/a><\/sup> Following the implementation of FDA regulation, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._Congress\" class=\"mw-redirect\" title=\"U.S. Congress\" rel=\"external_link\" target=\"_blank\">U.S. Congress<\/a> codified these standards and other requirements in the Medical Device User Fee Act of 2002.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"The_Single_Use_Label\">The Single Use Label<\/span><\/h3>\n<p>Original equipment manufacturers undergo a thorough analysis to determine whether a device should be single-use or reusable. Factors in determining to label a device single-use include but are not limited to possible infection\/sterility concerns and the risk of reduced efficacy. Depending on the device and its design, failure to completely clean a single-use device could lead to cross patient infection or there is the risk that the chemicals used to clean the device will themselves pose a risk to patients by being absorbed, for example, by the plastic from which the device is made and then subsequently leaching out into a patient's body. There can also be the risk of deterioration of the device when exposed to cleaning or sterilization processes which could lead to device malfunction. When a manufacturer designs and develops a product, it determines the materials used and how the device is labeled.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> In the U.S., to market a device as \u201c<a href=\"https:\/\/en.wikipedia.org\/wiki\/Reuse\" title=\"Reuse\" rel=\"external_link\" target=\"_blank\">reusable<\/a>\u201d, a manufacturer must provide increased data requirements and invest the resources necessary to demonstrate to FDA that the product can be safely reprocessed at the hospital level.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> Unlike reusable devices, single-use devices are not sold with instructions on how they can be properly cleaned and sterilized nor have they been validated or tested for exposure to cleaning or sterilization processes, including chemical exposure and heat.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Commonly_reprocessed_SUDs\">Commonly reprocessed SUDs<\/span><\/h2>\n<p>Commonly reprocessed medical devices include lower-risk, U.S. FDA Class I non-invasive devices such as sequential compression sleeves, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tourniquet\" title=\"Tourniquet\" rel=\"external_link\" target=\"_blank\">tourniquet<\/a> cuffs, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse_oximeter\" class=\"mw-redirect\" title=\"Pulse oximeter\" rel=\"external_link\" target=\"_blank\">pulse oximeter<\/a> sensors, to medium-risk, FDA Class II minimally invasive surgical devices including Ear, Nose and Throat microdebriders and cautery electrodes, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic\" class=\"mw-redirect\" title=\"Laparoscopic\" rel=\"external_link\" target=\"_blank\">laparoscopic<\/a> graspers, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scissors\" title=\"Scissors\" rel=\"external_link\" target=\"_blank\">scissors<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Forceps\" title=\"Forceps\" rel=\"external_link\" target=\"_blank\">forceps<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpels\" class=\"mw-redirect\" title=\"Scalpels\" rel=\"external_link\" target=\"_blank\">scalpels<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic\" class=\"mw-redirect\" title=\"Orthopedic\" rel=\"external_link\" target=\"_blank\">orthopedic<\/a> blades, bits, burs, <a href=\"https:\/\/en.wikipedia.org\/wiki\/External_fixation\" title=\"External fixation\" rel=\"external_link\" target=\"_blank\">external fixation<\/a> clamps, bolts and components, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrophysiological\" class=\"mw-redirect\" title=\"Electrophysiological\" rel=\"external_link\" target=\"_blank\">electrophysiological<\/a> cardiac <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheters\" class=\"mw-redirect\" title=\"Catheters\" rel=\"external_link\" target=\"_blank\">catheters<\/a>.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> To date, the FDA has not approved for reprocessing any Class III, or higher risk, SUDs.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"U.S._regulations_for_reprocessed_SUDs\">U.S. regulations for reprocessed SUDs<\/span><\/h2>\n<p>The Medical Device User Fee and Modernization Act of 2002 (MDUFMA), and Medical Device User Fee Stabilization Act of 2005 were signed into law on October 26, 2002, and August 1, 2005, respectively. All medical devices including reprocessed devices are subject to premarket review by the U.S. FDA, unless the agency has, by regulation, declared the device to be exempt from premarket requirements.<sup id=\"rdp-ebb-cite_ref-fda_a_1-1\" class=\"reference\"><a href=\"#cite_note-fda_a-1\" rel=\"external_link\">[1]<\/a><\/sup> Unless exempt, the lower risk \u201cClass I\u201d and \u201cClass II\u201d devices, whether \u201coriginal\u201d or reprocessed, are required to have cleared premarket notification submissions (\u201c510(k)s\u201d).<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> With regard to premarket review, reprocessors are subject to more stringent regulation by FDA than are OEMs<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> because MDUFMA, require FDA to withdraw premarket notification exemptions for a significant number of previously exempt reprocessed devices, although \u201coriginal\u201d devices remain exempt from premarket review.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\nReprocessors must also validate the cleaning and sterilization methods they seek to use in the reprocessing of a SUD, and include in their 510(k) submissions \u201cvalidation data [...] regarding cleaning, sterilization, and functional performance\u201d to show that the reprocessed device \u201cwill remain substantially equivalent [...] after the maximum number of times the device is reprocessed as intended\u201d.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> Both OEMs and reprocessors are subject to establishment registration and medical device listing; medical device reporting; medical device tracking; reports of corrections and removals, the quality system regulation (\u201cQSR\u201d); and labeling requirements.<sup id=\"rdp-ebb-cite_ref-Fda.gov_6-2\" class=\"reference\"><a href=\"#cite_note-Fda.gov-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Safety_and_efficacy_of_reprocessed_SUDs\">Safety and efficacy of reprocessed SUDs<\/span><\/h2>\n<p>FDA and the independent <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._Government_Accountability_Office\" class=\"mw-redirect\" title=\"U.S. Government Accountability Office\" rel=\"external_link\" target=\"_blank\">U.S. Government Accountability Office<\/a> (GAO) have concluded that there is no evidence of harm to patients from FDA-regulated reprocessed SUDs. A 2008 GAO report found that of the over 320,000 adverse events filed with FDA between 2000 and 2006, only 65 adverse events \u201cactually involved or were suspected to involve a reprocessed SUD and that the reprocessed SUD was one of several possible causal factors in the adverse event. In reviewing these 65 reports, FDA found that the types of adverse events reported to be associated with the use of reprocessed SUDs were the same types of events that were reported for new devices\u201d.<sup id=\"rdp-ebb-cite_ref-GAO_a_15-0\" class=\"reference\"><a href=\"#cite_note-GAO_a-15\" rel=\"external_link\">[15]<\/a><\/sup> The 2008 GAO report concluded: \u201cAfter reviewing the available evidence \u2013 including FDA\u2019s process for identifying and investigating device-related adverse events reported to involve reprocessed SUDs, peer-reviewed studies published since 2000, and the results of our and FDA\u2019s consultations with hospital representatives \u2013 we found no reason to question FDA\u2019s analysis indicating that no causative link has been established between reported injuries or deaths and reprocessed SUDs\".<sup id=\"rdp-ebb-cite_ref-GAO_a_15-1\" class=\"reference\"><a href=\"#cite_note-GAO_a-15\" rel=\"external_link\">[15]<\/a><\/sup> In a separate letter from FDA to Congressman Tom Davis and Harry Waxman dated January 23, 2006, FDA indicated that a total of 65,325 reports have been filed between 2003 and 2006 for the malfunction or injury associated with the first use of devices labeled for \u201csingle use.\u201d The same search produced 176 cases of apparent malfunction or injury associated with reprocessed devices. Upon analysis of the latter reports, FDA determined that these adverse events were not related to the reprocessing of the \u201csingle use\u201d device.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Benefits_of_reprocessing\">Benefits of reprocessing<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Economic\">Economic<\/span><\/h3>\n<p>FDA-regulated reprocessed devices cost between 40%-60% of an original device.<sup id=\"rdp-ebb-cite_ref-greenhealthmagazine_17-0\" class=\"reference\"><a href=\"#cite_note-greenhealthmagazine-17\" rel=\"external_link\">[17]<\/a><\/sup> Currently, reprocessors estimate that a typical 200-bed hospital, if taking advantage of a reprocessor\u2019s full product line, can save between $600,000 and $1 million a year and divert between 5,000 and 15,000 pounds of waste from landfills.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> According to a study by <a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Commonwealth_Fund\" class=\"mw-redirect\" title=\"The Commonwealth Fund\" rel=\"external_link\" target=\"_blank\">The Commonwealth Fund<\/a> with funding from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_Wood_Johnson_Foundation\" title=\"Robert Wood Johnson Foundation\" rel=\"external_link\" target=\"_blank\">Robert Wood Johnson Foundation<\/a> and Health Care Without Harm in November 2012, they estimated that from hospitals implementing a reprocessing program, cost savings over five years was about $57 per procedure, and that if hospitals nationwide adopted an SUD reprocessing intervention, cost savings would be $540 million annually, or $2.7 billion over five years.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Environmental\">Environmental<\/span><\/h3>\n<p>Regulated medical waste (RMW), or \u201cred bag waste,\u201d is a waste expenditure that typically costs hospitals 6 to 10 times more to dispose of than regular solid waste.<sup id=\"rdp-ebb-cite_ref-greenhealthmagazine_17-1\" class=\"reference\"><a href=\"#cite_note-greenhealthmagazine-17\" rel=\"external_link\">[17]<\/a><\/sup> Among the inventory of devices reprocessed annually, ninety-five percent (95%) are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Recycled\" class=\"mw-redirect\" title=\"Recycled\" rel=\"external_link\" target=\"_blank\">recycled<\/a> at the end of their <a href=\"https:\/\/en.wikipedia.org\/wiki\/Product_life_cycle\" class=\"mw-redirect\" title=\"Product life cycle\" rel=\"external_link\" target=\"_blank\">life cycle<\/a> rather than sent to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Landfills\" class=\"mw-redirect\" title=\"Landfills\" rel=\"external_link\" target=\"_blank\">landfills<\/a>.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> A variety of otherwise reprocessable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Raw_materials\" class=\"mw-redirect\" title=\"Raw materials\" rel=\"external_link\" target=\"_blank\">raw materials<\/a> that end up in a hospital\u2019s RMW include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a>, aluminum, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a>, gold, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polycarbonate\" title=\"Polycarbonate\" rel=\"external_link\" target=\"_blank\">polycarbonate<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyurethane\" title=\"Polyurethane\" rel=\"external_link\" target=\"_blank\">polyurethane<\/a>. Reprocessing has allowed some hospitals to divert over 8,000 pounds of RMW from landfills each year, while larger systems can divert more than 50,000 pounds.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Physician_and_Clinical_Statements_in_Support\">Physician and Clinical Statements in Support<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_College_of_Cardiology\" title=\"American College of Cardiology\" rel=\"external_link\" target=\"_blank\">American College of Cardiology<\/a> (ACC) (1999)<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup><\/li>\n<li>Association for Healthcare Resource and Materials Management (AHRMM) Reprocessing Advisory <sup id=\"rdp-ebb-cite_ref-ahrmm_23-0\" class=\"reference\"><a href=\"#cite_note-ahrmm-23\" rel=\"external_link\">[23]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Hospital_Association\" title=\"American Hospital Association\" rel=\"external_link\" target=\"_blank\">American Hospital Association<\/a> (AHA) (2000) <sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Medical_Association\" title=\"American Medical Association\" rel=\"external_link\" target=\"_blank\">American Medical Association<\/a> (AMA), Report of the Council on Scientific Affairs (I-00) (2000) <sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Nursing_Association\" class=\"mw-redirect\" title=\"American Nursing Association\" rel=\"external_link\" target=\"_blank\">American Nursing Association<\/a> (ANA), (2010)<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Association_of_periOperative_Registered_Nurses\" title=\"Association of periOperative Registered Nurses\" rel=\"external_link\" target=\"_blank\">Association of periOperative Registered Nurses<\/a> (AORN), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ascquality.org\/Library\/singleusedevicereprocessingtoolkit\/AORN%20Guidance%20Statement%20on%20Reuse%20of%20Single%20Use%20Devices%202006.pdf\" target=\"_blank\">Environmental Responsibility (2006)<\/a><sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup><\/li>\n<li>Practice Greenhealth <sup id=\"rdp-ebb-cite_ref-practicegreenhealth_28-0\" class=\"reference\"><a href=\"#cite_note-practicegreenhealth-28\" rel=\"external_link\">[28]<\/a><\/sup><\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mayo_Clinic\" title=\"Mayo Clinic\" rel=\"external_link\" target=\"_blank\">Mayo Clinic<\/a> (with AAOS and AHA), August 2, 2001 <sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"List_of_Known_Regulated_Third-Party_SUD_Reprocessing_Vendors\">List of Known Regulated Third-Party SUD Reprocessing Vendors<\/span><\/h2>\n<table class=\"wikitable\" style=\"\">\n<tbody><tr>\n<th>Regulated Vendor<\/th>\n<th>Location\n<\/th><\/tr>\n<tr>\n<td>Hygia Health Services<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup><\/td>\n<td>Birmingham, AL\n<\/td><\/tr>\n<tr>\n<td>Medline ReNewal<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup><\/td>\n<td>Redmond, OR\n<\/td><\/tr>\n<tr>\n<td>NEScientific<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup><\/td>\n<td>Waterbury, CT\n<\/td><\/tr>\n<tr>\n<td>ReNu Medical<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup><\/td>\n<td>Everett, WA\n<\/td><\/tr>\n<tr>\n<td>SterilMed, Inc<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup><\/td>\n<td>Maple Grove, MN\n<\/td><\/tr>\n<tr>\n<td>SteriPro Canada, Inc<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup><\/td>\n<td>Toronto, Canada\n<\/td><\/tr>\n<tr>\n<td>Stryker Sustainability Solutions<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup><\/td>\n<td>Lakeland, FL\n<\/td><\/tr>\n<tr>\n<td>SureTek Medical<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup><\/td>\n<td>Greenville, SC\n<\/td><\/tr>\n<tr>\n<td>Vanguard (International)<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup><\/td>\n<td>Berlin, Germany\n<\/td><\/tr>\n<\/tbody><\/table>\n<p>The Association of Medical Device Reprocessors (AMDR),<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup> based in Washington, D.C., is the global <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trade_association\" title=\"Trade association\" rel=\"external_link\" target=\"_blank\">trade association<\/a> consisting of members of the regulated, commercial single-use medical device reprocessing and remanufacturing industry. AMDR was founded in 1997 and the commercial single-use medical device reprocessors in the association now serve a majority of U.S. hospitals, including all the country\u2019s Honor Roll hospitals, as ranked by <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._News_%26_World_Report\" title=\"U.S. News & World Report\" rel=\"external_link\" target=\"_blank\">U.S. News & World Report<\/a>.\"<sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup>\n<\/p>\n<h2><span id=\"rdp-ebb-International_Regulation_of_.E2.80.9CSingle-Use.E2.80.9D_Medical_Device_Reprocessing\"><\/span><span class=\"mw-headline\" id=\"International_Regulation_of_\u201cSingle-Use\u201d_Medical_Device_Reprocessing\">International Regulation of \u201cSingle-Use\u201d Medical Device Reprocessing<\/span><\/h2>\n<p>The reprocessing of SUDs is commonplace worldwide. Even in developed nations, including those that have reprocessing prohibitions in place, hospitals routinely reuse SUDs in an unregulated manner. In many cases (particularly in Africa and Asia), uncontrolled reuse of such devices is relatively common, if not the norm.<sup id=\"rdp-ebb-cite_ref-Journal_a_41-0\" class=\"reference\"><a href=\"#cite_note-Journal_a-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"European_Union\">European Union<\/span><\/h3>\n<p>Currently, the European Union (EU) does not have a single policy regarding the reprocessing of SUDs. However, it is in the process of revising its Medical Device Directive. In 1993, at the issuance of the last Medical Device Directive, the issue of medical device reprocessing was identified as in need of additional clarification and the European Commission was instructed to submit a report on the issue by 2010.<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup> In August, 2010, the Commission released its report,<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup> highlighting the risks of unregulated reprocessing. Ultimately, the European Commission released its proposal<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup> and the European Parliament approved its draft<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup> (9 October 2013). Both legislative versions propose to regulate reprocessing as manufacturing. The European Council is now set to approve its own version of the legislation. Ultimately, both the Council and Parliament will have to agree, meeting in Trialogue with the European Commission, on the final version of the legislation. It is hoped the final agreement on the regulation will completed in 2015.\n<\/p><p>Until then, regulation of reprocessing activities is left to the individual Member States. Since 2001, Germany has had in place a regulatory framework that does not distinguish between the reprocessing of \u201creusable\u201d and so-called \u201csingle-use\u201d medical devices. The guidelines, therefore, allow for SUD reprocessing if conformance with certain standards is achieved. The German Medical Devices Law and the Medical Devices Operator Ordinance regulate the reprocessing of medical devices and in doing so refer to the mutual recommendation by the Robert Koch Institute (RKI) and the Federal Institute for Drugs and Medical Devices (BfArM) for the reprocessing of medical devices.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> As a result, the RKI\u2019s requirements must be observed.\n<\/p><p>Institutions, which want to reprocess single-use medical devices, must adopt and implement a quality management system according to DIN EN ISO 13485:2007. Compliance with the quality management requirements is monitored annually by \u201cNotified Bodies\u201d that have been accredited by the Central Authority of the L\u00e4nder for Health Protection with regard to Medicinal Products and Medical Devices (ZLG).\n<\/p><p>Other Member States, such as the United Kingdom, Spain and France,<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup> discourage or prohibit SUD reprocessing. The majority of Member States in Europe do not have any national regulations regarding reprocessing.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Africa_and_the_Middle_East\">Africa and the Middle East<\/span><\/h3>\n<p>The lack of resources, including medical devices and distribution channels, \u201cnecessitates the reuse of single-use devices\u201d in much of Africa.<sup id=\"rdp-ebb-cite_ref-Journal_a_41-1\" class=\"reference\"><a href=\"#cite_note-Journal_a-41\" rel=\"external_link\">[41]<\/a><\/sup> This includes the reuse of syringes and needles that have not been sterilized, and even rubber gloves. In the Middle East, available data indicates that reuse of SUDs is common throughout Arab countries (particularly for cardiac catheters), despite the absence of a regulatory framework. Reprocessing in both Africa and the Middle East is done at the user-facility level.<sup id=\"rdp-ebb-cite_ref-Journal_a_41-2\" class=\"reference\"><a href=\"#cite_note-Journal_a-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Israel\">Israel<\/span><\/h4>\n<p>Israel does not have regulations in place specific to the reprocessing of SUDs, but as a general matter, medical devices must be registered with the Ministry of Health (MOH) before they can be sold in the country. If a product is approved by the U.S. FDA, it will generally be registered by the MOH with no further testing requirements and, therefore, may be lawfully marketed in the country. Consistent with this policy, FDA-cleared reprocessed devices have been registered with MOH and are actively imported into the country.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Asia.2FJapan\"><\/span><span class=\"mw-headline\" id=\"Asia\/Japan\">Asia\/Japan<\/span><\/h3>\n<p>The reuse of SUDs in much of Asia is common, particularly for injection needles.<sup id=\"rdp-ebb-cite_ref-Journal_a_41-3\" class=\"reference\"><a href=\"#cite_note-Journal_a-41\" rel=\"external_link\">[41]<\/a><\/sup> For the most part, there are no national regulations governing reuse of SUDs and, thus, third-party reprocessors do not offer their services in Asia. Rather, most reuse in Asia is conducted in an unregulated-manner at the user-facility level. Reprocessing is not currently regulated in Japan, but, available data indicates that the reuse of SUDs is relatively common. A 2003 survey found that 80 to 90 percent of hospitals reused SUDs.<sup id=\"rdp-ebb-cite_ref-Journal_a_41-4\" class=\"reference\"><a href=\"#cite_note-Journal_a-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Australia\">Australia<\/span><\/h3>\n<p>Australia enacted regulations regarding the reprocessing (\u201cremanufacturing\u201d in Australia) of SUDs in 2003.<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup> Similar to the U.S., in Australia, all reprocessors (third-party, hospital, and OEM) must conform to medical device manufacturer requirements as regulated by the Therapeutic Goods Administration (TGA). Prior to implementation of these requirements, hospital reprocessing of SUDs was common.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Canada\">Canada<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_Canada\" title=\"Health Canada\" rel=\"external_link\" target=\"_blank\">Health Canada<\/a> does not currently regulate reprocessed single-use devices or the third-party companies that are reprocessing these devices for Canadian hospitals. Whether or not to reprocess a single-use device is determined by the territorial and provincial health ministries as well as hospital boards.<sup id=\"rdp-ebb-cite_ref-CADTH_a_51-0\" class=\"reference\"><a href=\"#cite_note-CADTH_a-51\" rel=\"external_link\">[51]<\/a><\/sup> A number of provinces have adopted similar positions that allow for the reprocessing of SUDs if the third party reprocessor is regulated by the FDA.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"British_Columbia\">British Columbia<\/span><\/h4>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/British_Columbia\" title=\"British Columbia\" rel=\"external_link\" target=\"_blank\">British Columbia<\/a> issued a policy to its health authorities stating that by January 1, 2008, all health authorities must have eliminated the reprocessing and reuse of critical contact SUDs, unless they have been reprocessed by a licensed third-party reprocessor that is certified by a national regulatory authority such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_Canada\" title=\"Health Canada\" rel=\"external_link\" target=\"_blank\">Health Canada<\/a> or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._Food_and_Drug_Administration\" class=\"mw-redirect\" title=\"U.S. Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">U.S. Food and Drug Administration<\/a>.<sup id=\"rdp-ebb-cite_ref-CADTH_a_51-1\" class=\"reference\"><a href=\"#cite_note-CADTH_a-51\" rel=\"external_link\">[51]<\/a><\/sup> The policy was revised in 2011 with additional information that sharps (e.g. scalpel blades, drill bits, saw blades, shavers) and needles shall be single-use and shall not be reprocessed.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Manitoba\">Manitoba<\/span><\/h4>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Manitoba\" title=\"Manitoba\" rel=\"external_link\" target=\"_blank\">Manitoba<\/a> does not permit hospitals to reuse SUDs in-house, but does permit hospitals to contract with an FDA regulated vendor, among other requirements.<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Alberta\">Alberta<\/span><\/h4>\n<p>Alberta Health Services issued a policy in 2012 prohibiting the reuse and reprocessing of both critical and semi-critical single-use medical devices.<sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Northwest_Territories\">Northwest Territories<\/span><\/h4>\n<p>Since 2005, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Northwest_Territories\" title=\"Northwest Territories\" rel=\"external_link\" target=\"_blank\">Northwest Territories<\/a> have prohibited reprocessing. Specifically, the Northwest Territories Department of Health and Social Services revised its Hospital and Health Care Facility Standards Regulations to require that \u201ca disposable device intended to be used on a patient during a single procedure shall not be used on a patient for more than one procedure and shall not be used on another patient.\" <sup id=\"rdp-ebb-cite_ref-CADTH_a_51-2\" class=\"reference\"><a href=\"#cite_note-CADTH_a-51\" rel=\"external_link\">[51]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Ontario\">Ontario<\/span><\/h4>\n<p>In 2006, the Ontario Ministry of Health and Long Term Care endorsed a guidance document developed by its Provincial Infectious Diseases Advisory Committee (PIDAC) advising that critical and semi-critical SUDs must not be reprocessed and reused, unless the reprocessing is done by a licensed reprocessor.<sup id=\"rdp-ebb-cite_ref-CADTH_a_51-3\" class=\"reference\"><a href=\"#cite_note-CADTH_a-51\" rel=\"external_link\">[51]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Saskatchewan\">Saskatchewan<\/span><\/h4>\n<p>In 2013, The Saskatchewan Ministry of Health affirmed a policy outlining requirements for hospitals that reprocess SUDs. Consistent with the policies of other provinces, Saskatchewan requires, among other things, that hospitals outsource to an FDA regulated vendor.<sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-fda_a-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-fda_a_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fda_a_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/ReprocessingofSingle-UseDevices\/\" target=\"_blank\">\"Reprocessing of Single-Use Devices\"<\/a>. Fda.gov. 2006-09-26<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Reprocessing+of+Single-Use+Devices&rft.pub=Fda.gov&rft.date=2006-09-26&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FReprocessingofSingle-UseDevices%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.amhmagazine.com\/article.php?article_id=818\" target=\"_blank\">\"A Winning Approach | AMH Magazine - Preventing Infection in Medical Treatment\"<\/a>. AMH Magazine<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=A+Winning+Approach+%26%23124%3B+AMH+Magazine+-+Preventing+Infection+in+Medical+Treatment&rft.pub=AMH+Magazine&rft_id=http%3A%2F%2Fwww.amhmagazine.com%2Farticle.php%3Farticle_id%3D818&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Landro, Laura (2008-03-19). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.wsj.com\/articles\/SB120588469924246975\" target=\"_blank\">\"Hospitals Reuse Medical Devices To Lower Costs - WSJ.com\"<\/a>. Online.wsj.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Hospitals+Reuse+Medical+Devices+To+Lower+Costs+-+WSJ.com&rft.pub=Online.wsj.com&rft.date=2008-03-19&rft.aulast=Landro&rft.aufirst=Laura&rft_id=https%3A%2F%2Fwww.wsj.com%2Farticles%2FSB120588469924246975&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Rodak, Sabrina (2013-06-14). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.beckersasc.com\/asc-supply-chain-materials-management\/reprocessing-saves-up-to-20k-per-or-annually.html\" target=\"_blank\">\"Reprocessing Saves Up to $20k Per OR Annually\"<\/a>. Beckersasc.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Reprocessing+Saves+Up+to+%2420k+Per+OR+Annually&rft.pub=Beckersasc.com&rft.date=2013-06-14&rft.aulast=Rodak&rft.aufirst=Sabrina&rft_id=http%3A%2F%2Fwww.beckersasc.com%2Fasc-supply-chain-materials-management%2Freprocessing-saves-up-to-20k-per-or-annually.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-fda-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-fda_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fda_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/NewsEvents\/Testimony\/ucm114926.htm\" target=\"_blank\">\"Reuse of Medical Devices Labeled for Single-use\"<\/a>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Reuse+of+Medical+Devices+Labeled+for+Single-use&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.fda.gov%2FNewsEvents%2FTestimony%2Fucm114926.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Fda.gov-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Fda.gov_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Fda.gov_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Fda.gov_6-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/GuidanceDocuments\/ucm107164.htm\" target=\"_blank\">\"Enforcement Priorities for Single-Use Devices Reprocessed by Third Parties and Hospitals\"<\/a>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Enforcement+Priorities+for+Single-Use+Devices+Reprocessed+by+Third+Parties+and+Hospitals&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FGuidanceDocuments%2Fucm107164.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"#19\">\"MDUFMA Frequently Asked Questions\"<\/a>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=MDUFMA+Frequently+Asked+Questions&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FOverview%2FMedicalDeviceUserFeeandModernizationActMDUFMA%2Fucm109208.htm%2319&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Office, U. S. Government Accountability (2008-03-03). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gao.gov\/products\/GAO-08-147\" target=\"_blank\">\"Reprocessed Single Use Devices: FDA Oversight Has Increased, and Available Information Does Not Indicate That Use Presents an Elevated Health Risk\"<\/a> (GAO-08\u2013147). GAO-08-147: Published: Jan 31, 2008. Publicly Released: Mar 3, 2008.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Reprocessed+Single+Use+Devices%3A+FDA+Oversight+Has+Increased%2C+and+Available+Information+Does+Not+Indicate+That+Use+Presents+an+Elevated+Health+Risk&rft.issue=GAO-08%E2%80%93147&rft.date=2008-03-03&rft.aulast=Office&rft.aufirst=U.+S.+Government+Accountability&rft_id=http%3A%2F%2Fwww.gao.gov%2Fproducts%2FGAO-08-147&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/GuidanceDocuments\/ucm252999.htm\" target=\"_blank\">\"Draft Guidance for Industry and FDA Staff - Processing\/Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling\"<\/a>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Draft+Guidance+for+Industry+and+FDA+Staff+-+Processing%2FReprocessing+Medical+Devices+in+Health+Care+Settings%3A+Validation+Methods+and+Labeling&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FGuidanceDocuments%2Fucm252999.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/ReprocessingofSingle-UseDevices\/ucm121218.htm\" target=\"_blank\">\"List of Single-Use Devices Known To Be Reprocessed or Considered for Reprocessing (Attachment 1)\"<\/a>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=List+of+Single-Use+Devices+Known+To+Be+Reprocessed+or+Considered+for+Reprocessing+%28Attachment+1%29&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FReprocessingofSingle-UseDevices%2Fucm121218.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/ReprocessingofSingle-UseDevices\/ucm121213.htm\" target=\"_blank\">\"List 2 - Reprocessed Single-Use Devices Subject to Premarket Notification Requirements That Now Require the Submission of Validation\"<\/a>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=List+2+-+Reprocessed+Single-Use+Devices+Subject+to+Premarket+Notification+Requirements+That+Now+Require+the+Submission+of+Validation&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FReprocessingofSingle-UseDevices%2Fucm121213.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Testimony of Dr. Daniel Schultz, Director, CDRH, FDA (September 26, 2006) (\"Congress mandated a number of new requirements for SUD reprocessors including, for certain SUDs, the pre-market submission of data to the agency that exceeded the requirements for the original manufacturers (OEMs)\" <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/ReprocessingofSingle-UseDevices\/ucm121067.htm\" target=\"_blank\">http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/ReprocessingofSingle-UseDevices\/ucm121067.htm<\/a><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"#3\">\"Guidance for Industry and FDA Staff - Medical Device User Fee and Modernization Act of 2002, Validation Data in Premarket Notification Submissions (510(k)s) for Reprocessed Single-Use Medical Devices\"<\/a>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Guidance+for+Industry+and+FDA+Staff+-+Medical+Device+User+Fee+and+Modernization+Act+of+2002%2C+Validation+Data+in+Premarket+Notification+Submissions+%28510%28k%29s%29+for+Reprocessed+Single-Use+Medical+Devices&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FGuidanceDocuments%2Fucm071434.htm%233&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gpo.gov\/fdsys\/pkg\/FR-2003-04-30\/pdf\/03-10413.pdf\" target=\"_blank\">\"68 Fed. Reg. 23139\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. April 30, 2003.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=68+Fed.+Reg.+23139&rft.date=2003-04-30&rft_id=http%3A%2F%2Fwww.gpo.gov%2Ffdsys%2Fpkg%2FFR-2003-04-30%2Fpdf%2F03-10413.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> citing 21 U.S.C. \u00a7 360(o) (emphasis added). For a full description of the validation data reprocessors must submit on a premarket basis, including more particular guidance on cleaning, functional testing, and sterilization data requirements, see Guidance for Industry and FDA Staff: Medical Device User Fee and Modernization Act of 2002, Validation Data in Premarket Notification Submissions (510(k)s) for Reprocessed Medical Devices (Sept. 25, 2006), at 15<\/span>\n<\/li>\n<li id=\"cite_note-GAO_a-15\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-GAO_a_15-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-GAO_a_15-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">U.S. Government Accountability Office, GAO-08-147, Reprocessed Single-Use Medical Devices: FDA Oversight Has Increased, and Available Information Does Not Indicate That Use Presents an Elevated Health Risk (January 2008), at 1 <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.gao.gov\/new.items\/d08147.pdf\" target=\"_blank\">http:\/\/www.gao.gov\/new.items\/d08147.pdf<\/a>; See also, GAO\u2019s 2000 report:<\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.amdr.org\/wp-content\/uploads\/2014\/03\/FDA-response-01.23.06.pdf\" target=\"_blank\">\"Letter from FDA to Congressman Tom Davis and Harry Waxman dated January 23, 2006\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Fda.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Letter+from+FDA+to+Congressman+Tom+Davis+and+Harry+Waxman+dated+January+23%2C+2006&rft.pub=Fda.gov&rft_id=http%3A%2F%2Fwww.amdr.org%2Fwp-content%2Fuploads%2F2014%2F03%2FFDA-response-01.23.06.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-greenhealthmagazine-17\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-greenhealthmagazine_17-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-greenhealthmagazine_17-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Sheehan, Kaeleigh. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/greenhealthmagazine.org\/reprocess-and-reuse\/\" target=\"_blank\">\"Reprocess and Reuse\"<\/a>. Greenhealth Magazine<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Reprocess+and+Reuse&rft.pub=Greenhealth+Magazine&rft.aulast=Sheehan&rft.aufirst=Kaeleigh&rft_id=http%3A%2F%2Fgreenhealthmagazine.org%2Freprocess-and-reuse%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.usitc.gov\/publications\/332\/pub4356.pdf\" target=\"_blank\">\"Remanufactured Goods: An Overview\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Usitc.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-03-07<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Remanufactured+Goods%3A+An+Overview&rft.pub=Usitc.gov&rft_id=http%3A%2F%2Fwww.usitc.gov%2Fpublications%2F332%2Fpub4356.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">SuSan Kaplan, Blair Sadler, Kevin little, Calvin Franz, and Peter OrrisS <cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/DeviceRegulationandGuidance\/ReprocessingofSingle-UseDevices\/ucm121218.htm\" target=\"_blank\">\"Can Sustainable Hospitals Help Bend the Health Care Cost Curve?\"<\/a>. The Commonwealth Fund<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-10-24<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Can+Sustainable+Hospitals+Help++Bend+the+Health+Care+Cost+Curve%3F&rft.pub=The+Commonwealth+Fund&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FDeviceRegulationandGuidance%2FReprocessingofSingle-UseDevices%2Fucm121218.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.usitc.gov\/press_room\/documents\/testimony\/332_525_015.pdf\" target=\"_blank\">\"AMDR Statement\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Usitc.gov<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-03-07<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=AMDR+Statement&rft.pub=Usitc.gov&rft_id=http%3A%2F%2Fwww.usitc.gov%2Fpress_room%2Fdocuments%2Ftestimony%2F332_525_015.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/healthierhospitals.org\/sites\/default\/files\/IMCE\/public_files\/Pdfs\/hhi_2012_milestone_report.pdf\" target=\"_blank\">\"Healthier Hospitals Initiative 2012 Milestone Report\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Healthierhosptials.org<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-03-07<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Healthier+Hospitals+Initiative+2012+Milestone+Report&rft.pub=Healthierhosptials.org&rft_id=http%3A%2F%2Fhealthierhospitals.org%2Fsites%2Fdefault%2Ffiles%2FIMCE%2Fpublic_files%2FPdfs%2Fhhi_2012_milestone_report.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/amdr.org\/documents\/ACCLtrtoRichardDurbin.pdf\" target=\"_blank\">\"Letter from American College of Cardiology to Senator Richard Durbin in support of reprocessing\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. 1999.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Letter+from+American+College+of+Cardiology+to+Senator+Richard+Durbin+in+support+of+reprocessing&rft.date=1999&rft_id=http%3A%2F%2Famdr.org%2Fdocuments%2FACCLtrtoRichardDurbin.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ahrmm-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ahrmm_23-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ahrmm.org\/ahrmm\/news_and_issues\/issues_and_initiatives\/reprocessing_advisory\/index.jsp\" target=\"_blank\">\"Reprocessing Advisory\"<\/a>. ahrmm.org<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-03-30<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Reprocessing+Advisory&rft.pub=ahrmm.org&rft_id=http%3A%2F%2Fwww.ahrmm.org%2Fahrmm%2Fnews_and_issues%2Fissues_and_initiatives%2Freprocessing_advisory%2Findex.jsp&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.amdr.org\/wp-content\/uploads\/2011\/03\/AHA-Ltr-to-Thad-Cochran.pdf\" target=\"_blank\">\"Letter from American Hospital Association to Senator Thad Cochran in support of reprocessing\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. 1999.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Letter+from+American+Hospital+Association+to+Senator+Thad+Cochran+in+support+of+reprocessing&rft.date=1999&rft_id=http%3A%2F%2Fwww.amdr.org%2Fwp-content%2Fuploads%2F2011%2F03%2FAHA-Ltr-to-Thad-Cochran.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.amdr.org\/wp-content\/uploads\/2014\/10\/AMA-Report-on-Reuse_1.pdf\" target=\"_blank\">\"2000 Interim Meeting of the American Medical Association, Reports of the Council on Scientific Affairs\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=2000+Interim+Meeting+of+the+American+Medical+Association%2C+Reports+of+the+Council+on+Scientific+Affairs&rft_id=http%3A%2F%2Fwww.amdr.org%2Fwp-content%2Fuploads%2F2014%2F10%2FAMA-Report-on-Reuse_1.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nursingworld.org\/MainMenuCategories\/WorkplaceSafety\/Healthy-Work-Environment\/Environmental-Health\/PolicyIssues\/Single-Use-Devices.pdf\" target=\"_blank\">\"American Nursing Association 2010 House of Delegates Resolution: Safety and Effectiveness of Reprocessed Single Use Devices in Healthcare\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. 2010.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=American+Nursing+Association+2010+House+of+Delegates+Resolution%3A+Safety+and+Effectiveness+of+Reprocessed+Single+Use+Devices+in+Healthcare&rft.date=2010&rft_id=http%3A%2F%2Fwww.nursingworld.org%2FMainMenuCategories%2FWorkplaceSafety%2FHealthy-Work-Environment%2FEnvironmental-Health%2FPolicyIssues%2FSingle-Use-Devices.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"> <span class=\"cs1-format\">(PDF)<\/span> <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/amdr.org\/documents\/APICsingleusedevicepositionChangesIncluded-Final8_31_07-r.pdf\" target=\"_blank\">http:\/\/amdr.org\/documents\/APICsingleusedevicepositionChangesIncluded-Final8_31_07-r.pdf<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft_id=http%3A%2F%2Famdr.org%2Fdocuments%2FAPICsingleusedevicepositionChangesIncluded-Final8_31_07-r.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span> <span class=\"cs1-visible-error error citation-comment\">Missing or empty <code class=\"cs1-code\">|title=<\/code> (<a href=\"#citation_missing_title\" title=\"Help:CS1 errors\" rel=\"external_link\">help<\/a>)<\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-practicegreenhealth-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-practicegreenhealth_28-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/practicegreenhealth.org\/node\/16157\" target=\"_blank\">\"Frequently Asked Questions | Practice Greenhealth\"<\/a>. practicegreenhealth.org<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-03-30<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Frequently+Asked+Questions+%26%23124%3B+Practice+Greenhealth&rft.pub=practicegreenhealth.org&rft_id=https%3A%2F%2Fpracticegreenhealth.org%2Fnode%2F16157&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/amdr.org\/documents\/MayoAAOSAHAltrtoThompson8-2-01.pdf\" target=\"_blank\">\"Letter from Mayo Clinic to Secretary Tommy Thompson, Department of Health and Human Services\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. 2001.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Letter+from+Mayo+Clinic+to+Secretary+Tommy+Thompson%2C+Department+of+Health+and+Human+Services&rft.date=2001&rft_id=http%3A%2F%2Famdr.org%2Fdocuments%2FMayoAAOSAHAltrtoThompson8-2-01.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.hygia.net\/\" target=\"_blank\">http:\/\/www.hygia.net\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.medlinerenewal.com\/\" target=\"_blank\">http:\/\/www.medlinerenewal.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.mdreprocess.com\/\" target=\"_blank\">http:\/\/www.mdreprocess.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/renumedical.com\/\" target=\"_blank\">http:\/\/renumedical.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.sterilmed.com\/\" target=\"_blank\">http:\/\/www.sterilmed.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.steriprocanada.com\/\" target=\"_blank\">http:\/\/www.steriprocanada.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/sustainability.stryker.com\/\" target=\"_blank\">http:\/\/sustainability.stryker.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/suretekmedical.com\/\" target=\"_blank\">http:\/\/suretekmedical.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-38\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-38\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.vanguard-healthcare.com\/\" target=\"_blank\">http:\/\/www.vanguard-healthcare.com\/<\/a> Official Website<\/span>\n<\/li>\n<li id=\"cite_note-39\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-39\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.amdr.org\/\" target=\"_blank\">\"Home\"<\/a>. <i>AMDR home page<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">14 May<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=AMDR+home+page&rft.atitle=Home&rft_id=http%3A%2F%2Fwww.amdr.org%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-40\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-40\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/amdr.org\/2017\/09\/amdr-members-are-serving-all-of-u-s-news-world-reports-honor-roll-hospitals\/\" target=\"_blank\">\"AMDR members are serving all of U.S. News & World Report's \"honor roll\" hospitals\"<\/a>. <i>AMDR Top Hopsitals<\/i>. 2017-09-19<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">14 May<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=AMDR+Top+Hopsitals&rft.atitle=AMDR+members+are+serving+all+of+U.S.+News+%26+World+Report%27s+%22honor+roll%22+hospitals&rft.date=2017-09-19&rft_id=http%3A%2F%2Famdr.org%2F2017%2F09%2Famdr-members-are-serving-all-of-u-s-news-world-reports-honor-roll-hospitals%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Journal_a-41\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Journal_a_41-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Journal_a_41-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Journal_a_41-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Journal_a_41-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Journal_a_41-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Popp, Walter; Rasslan, Ossama; Unahalekhaka, Akeau; Brenner, Pola; Fischnaller, Edith; Fathy, Maha; Goldman, Carol; Gillespie, Elizabeth (July 2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S1438463910000441\" target=\"_blank\">\"What is the use? An international look at reuse of single-use medical devices\"<\/a>. <i>International Journal of Hygiene and Environmental Health<\/i>. <b>213<\/b> (4): 302\u2013307. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ijheh.2010.04.003\" target=\"_blank\">10.1016\/j.ijheh.2010.04.003<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20471316\" target=\"_blank\">20471316<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Hygiene+and+Environmental+Health&rft.atitle=What+is+the+use%3F+An+international+look+at+reuse+of+single-use+medical+devices&rft.volume=213&rft.issue=4&rft.pages=302-307&rft.date=2010-07&rft_id=info%3Adoi%2F10.1016%2Fj.ijheh.2010.04.003&rft_id=info%3Apmid%2F20471316&rft.aulast=Popp&rft.aufirst=Walter&rft.au=Rasslan%2C+Ossama&rft.au=Unahalekhaka%2C+Akeau&rft.au=Brenner%2C+Pola&rft.au=Fischnaller%2C+Edith&rft.au=Fathy%2C+Maha&rft.au=Goldman%2C+Carol&rft.au=Gillespie%2C+Elizabeth&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS1438463910000441&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASingle+Use+Medical+Device+Reprocessing\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-42\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"Council Directive 93\/42\/EEC (14 June 1993), Article 12a, OJ L 169, 12.7.1993, p. 1.\"<\/span>\n<\/li>\n<li id=\"cite_note-43\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-43\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"Report from the Commission to the European Parliament and the Council: Report on the Issue of the Reprocessing of Medical Devices in the European Union, in Accordance with Article 12a of Directive 93\/42\/EEC, European Commission (27 August 2010).\"<\/span>\n<\/li>\n<li id=\"cite_note-44\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-44\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"European Commission, Proposal for a REGULATION OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL, on medical devices, and amending Directive 2001\/83\/EC, Regulation (EC) No 178\/2002 and Regulation (EC) No 1223\/2009 (26 September 2012).\"<\/span>\n<\/li>\n<li id=\"cite_note-45\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-45\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"European Parliament, Report on the proposal for a regulation of the European Parliament and of the Council on medical devices, and amending Directive 2001\/83\/EC, Regulation (EC) No 178\/2002 and Regulation (EC) No 1223\/2009 (COM(2012)0542 \u2013 C7-0318\/2012 \u2013 2012\/0266(COD)), Committee on the Environment, Public Health and Food Safety (9 October 2013).\"<\/span>\n<\/li>\n<li id=\"cite_note-46\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-46\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"Hygienic Requirements for Processing of Medical Devices: Recommendation by the Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute (RKI) and the Federal German Institute for Medical Drugs and Medical Products (BfArM) Concerning the \"Hygienic Requirements for Processing of Medical Devices,\" Robert Koch Institute: Recommendation (2001).\"<\/span>\n<\/li>\n<li id=\"cite_note-47\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-47\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Commission Report, supra note 2, at 6. See also, Circulaire DGS\/DH n 51 (December 29, 1994) Relative a l\u2019utilisation des dispositifs medicaux steriles a usage unique dans les etblissements de sant\u00e9 publics et prives (France), Ministerio de sanidad y consume, Royal Decree 414.1996 Sec. 5, (July 9, 1999) (Spain) and MHRA Device Bulletin: DB 2006(04) Single-Use Medical Devices: Implications and Consequences of Reuse (UK).\"<\/span>\n<\/li>\n<li id=\"cite_note-48\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-48\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Commission Report, supra note 2, at 6. See also, European Association of Medical Device Reprocessors.\"<\/span>\n<\/li>\n<li id=\"cite_note-49\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-49\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"Medical Device Regulatory Requirements for Israel,\", U.S. International Trade Administration (May 2, 2005) <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.ita.doc.gov\/td\/health\/israelregs.html\" target=\"_blank\">http:\/\/www.ita.doc.gov\/td\/health\/israelregs.html<\/a><\/span>\n<\/li>\n<li id=\"cite_note-50\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-50\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"Statement by the TGA on regulations for sterilisation of single use devices,\" Australian Government, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Therapeutic_Goods_Administration\" title=\"Therapeutic Goods Administration\" rel=\"external_link\" target=\"_blank\">Therapeutic Goods Administration<\/a> (July 21, 2003) <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.tga.gov.au\/archive\/media-2003-sud-030721.htm\" target=\"_blank\">http:\/\/www.tga.gov.au\/archive\/media-2003-sud-030721.htm<\/a><\/span>\n<\/li>\n<li id=\"cite_note-CADTH_a-51\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-CADTH_a_51-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CADTH_a_51-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CADTH_a_51-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-CADTH_a_51-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">CADTH Report \"Issue Analysis Summary: The Reuse of Single-Use Medical Devices,\" Health Canada; Therapeutic Products Directorate (April 28, 2005) <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.hc-sc.gc.ca\/dhp-mps\/alt_formats\/hpfb-dgpsa\/pdf\/md-im\/saprmd_ias_gcsrmm_raq_2005-06-09-eng.pdf\" target=\"_blank\">http:\/\/www.hc-sc.gc.ca\/dhp-mps\/alt_formats\/hpfb-dgpsa\/pdf\/md-im\/saprmd_ias_gcsrmm_raq_2005-06-09-eng.pdf<\/a>. See also, \"Reprocessing Single-Use Medical Devices: An Update of the Clinical Evidence and An Environmental Scan of Policies in Canada,\" Canadian Agency for Drugs and Technologies in Health (June 23, 2010) <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.cadth.ca\/media\/pdf\/ES8_Reprocessing_SUDs_e.pdf\" target=\"_blank\">http:\/\/www.cadth.ca\/media\/pdf\/ES8_Reprocessing_SUDs_e.pdf<\/a><\/span>\n<\/li>\n<li id=\"cite_note-52\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-52\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Manitoba Deputy Health Minister\u2019s Office (March 21, 2013)<\/span>\n<\/li>\n<li id=\"cite_note-53\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-53\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Alberta Health Services. Single Use Medical Devices Policy. May 1, 2012 <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.albertahealthservices.ca\/6444.asp\" target=\"_blank\">http:\/\/www.albertahealthservices.ca\/6444.asp<\/a><\/span>\n<\/li>\n<li id=\"cite_note-54\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-54\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Saskatchewan Health, Deputy Minister\u2019s Office (June 27, 2013)<\/span>\n<\/li>\n<\/ol><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1332\nCached time: 20181217094304\nCache expiry: 86400\nDynamic content: true\nCPU time usage: 0.376 seconds\nReal time usage: 0.447 seconds\nPreprocessor visited node count: 1598\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 54220\/2097152 bytes\nTemplate argument size: 1174\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 93093\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.191\/10.000 seconds\nLua memory usage: 3.96 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 375.000 1 -total\n<\/p>\n<pre>71.75% 269.070 1 Template:Reflist\n46.07% 172.778 28 Template:Cite_web\n17.70% 66.393 1 Template:Orphan\n13.59% 50.953 1 Template:Draft_other\n12.85% 48.171 1 Template:Ambox\n 9.24% 34.655 2 Template:Cite_journal\n 0.74% 2.775 1 Template:Monthyear\n 0.71% 2.675 1 Template:Main_other\n 0.71% 2.662 2 Template:PAGENAMEU\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:39722261-1!canonical and timestamp 20181217094303 and revision id 865904101\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Single_Use_Medical_Device_Reprocessing\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214714\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.158 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 150.354 1 - wikipedia:Single_Use_Medical_Device_Reprocessing\n100.00% 150.354 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8581-0!*!*!*!*!*!* and timestamp 20181217214714 and revision id 25010\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Single-use_medical_device_reprocessing\">https:\/\/www.limswiki.org\/index.php\/Single-use_medical_device_reprocessing<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","c9e7e589abaded1dc205bee7420521de_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/6c\/Wiki_letter_w.svg\/80px-Wiki_letter_w.svg.png"],"c9e7e589abaded1dc205bee7420521de_timestamp":1545083234,"5afb8d61cafaef8f2b60892a52bd104d_type":"article","5afb8d61cafaef8f2b60892a52bd104d_title":"Sharps waste","5afb8d61cafaef8f2b60892a52bd104d_url":"https:\/\/www.limswiki.org\/index.php\/Sharps_waste","5afb8d61cafaef8f2b60892a52bd104d_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSharps waste\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Sharps \u2013 like needles, syringes, lancets and other devices used at home to treat diabetes, arthritis, cancer, and other diseases \u2013 should be immediately disposed-of after use\nSharps waste is a form of biomedical waste composed of used \"sharps\", which includes any device or object used to puncture or lacerate the skin. Sharps waste is classified as biohazardous waste and must be carefully handled. Common medical materials treated as sharps waste are:\n\nHypodermic needles\nDisposable scalpels and blades\nContaminated glass and some plastics\nContents \n\n1 Qualifying materials \n2 Dangers involved \n3 Sharps containers \n4 Injection technology \n5 In the developing world \n6 Further reading \n7 References \n8 External links \n\n\nQualifying materials \nIn addition to needles and blades, anything attached to them will also be considered sharps waste, such syringes and injection devices.\nBlades can include razors, scalpels, X-Acto knife, scissors, or any other medical items used for cutting in the medical setting, regardless of if they have been contaminated with biohazardous material. While glass and sharp plastic are considered sharps waste, their handling methods can vary.\nGlass items which have been contaminated with a biohazardous material will be treated with the same concern as needles and blades, even if unbroken. If glass is contaminated, it is still often treated as a sharp, because it can break during the disposal process. Contaminated plastic items which are not sharp can be disposed of in a biohazardous waste receptacle instead of a sharps container.\n\nDangers involved \nAs a biohazardous material, injuries from sharps waste can pose a large public health concern. By penetrating the skin, it is possible for this waste to spread blood-borne pathogens. The spread of these pathogens is directly responsible for the transmission of blood-borne diseases, such as hepatitis B (HBV), hepatitis C (HCV), and HIV. Health care professionals expose themselves to the risk of transmission of these diseases when handling sharps waste. The large volume handled by health care professionals on a daily basis increases the chance that an injury may occur.\nThe general public can occasionally be at risk to injuries from sharps waste as well when improperly disposed of by injection drug users.\n\nSharps containers \n A sharps container is specially designed for safe disposal of sharps waste.\nA sharps container is a hard plastic container that is used to safely dispose of hypodermic needles and other sharp medical instruments, such as an IV catheters and disposable scalpels. Sharps containers may be single use which are disposed of with the waste inside, or reusable which are robotically emptied and sterilized before being returned for re-use.\nNeedles are dropped into the container through an opening in the top. Needles should never be pushed or forced into the container, as damage to the container and\/or needlestick injuries may result. Sharps containers should not be filled above the indicated line, usually two-thirds full.\nIn North America, sharps containers are often red, and elsewhere are often yellow.\nAirports and large institutions commonly have sharps containers available in restrooms for safe disposal for users of injection drugs, such as insulin-dependent diabetics. People injecting drugs in their homes may substitute other hard-sided containers such as empty milk jugs for disposal of needles.\nExtreme care must be taken in the management and disposal of sharps waste. The goal in sharps waste management is to safely handle all materials until they can be properly disposed. The final step in the disposal of sharps waste is to dispose of them in an autoclave. A less common approach is to incinerate them; typically only chemotherapy sharps waste is incinerated. Steps must be taken along the way to minimize the risk of injury from this material, while maximizing the amount of sharps material disposed.[citation needed ]\nHealth care workers are to minimize their interaction with sharps waste by disposing of it in a sealable container. Attempts by health care workers to disassemble sharps waste is kept to a minimum. Strict hospital protocols and government regulations ensure that hospital workers handle sharps waste safely and dispose of it effectively.\nSelf-locking and sealable sharps containers are made of plastic so that the sharps can not easily penetrate through the sides. Such units are designed so that the whole container can be disposed of with other biohazardous waste. Single use sharps containers of various sizes are sold throughout the world. Large medical facilities may have their own 'mini' autoclave in which these sharps containers are disposed of with other medical wastes. This minimizes the distance the containers have to travel and the number of people to come in contact with the sharps waste. Smaller clinics or offices without such facilities are required by federal regulations to hire the services of a company that specializes in transporting and properly disposing of the hazardous wastes.\nNIOSH found through results from focus groups that accommodation, functionality, accessibility, and visibility are four areas of high importance to be able to ensure safe discarding of sharps. The studies found it was important to have containers that are easy to use with little need for training to be able to use. The containers should be visible in any areas that sharps are used and be placed in such degree that spillage and injury will not be likely to occur with use.[1]\nRecent legislation in France has stated that pharmaceutical companies supplying self injection medications are responsible for the disposal of spent needles. Previously popular needle clippers and caps are no longer acceptable as safety devices and either sharps box or needle destruction devices are required.[citation needed ]\nDisposal methods vary by country and locale, but common methods of disposal are either by truck service or, in the United States, by disposal of sharps through the mail. Truck service involves trained personnel collecting sharps waste, and often medical waste, at the point of generation and hauling it away by truck to a destruction facility. Similarly, the mail-back sharps disposal method allows generators to ship sharps waste to the disposal facility directly through the U.S. mail in specially designed and approved shipping containers. Mail-back sharps disposal allows waste generators to dispose of smaller amounts of sharps more economically than if they were to hire out a truck service.\n\nInjection technology \nWith more than sixteen billion injections administered annually worldwide,[2] they are the largest contributor to sharps waste. For this reason many new technologies surrounding injections have been developed, mostly related to safety mechanisms. As these technologies have been developed governments have attempted to make them commonplace to ensure sharps waste safety. In 2000, the Needlestick Safety and Prevention Act was passed, along with the 2001 Bloodborne Pathogens Standard.[3]\nSafety syringes help reduce occurrences of accidental needlesticks. One of the most recent developments has been the auto-disable injection device. These injection devices automatically disable after a single use. This can be done by retracting the needle back into the syringe or rendering the syringe plunger inoperable. With the injection device now inoperable, it cannot be reused. Shielding the needle after the injection is another approach for safe management of sharps. These are hands free methods usually involving a hinging cap that can be pressed on a table to seal the needle. Another technology in sharps waste management relating to injections is the needle remover. Varying approaches can be taken with the main goal to separate the needle from the syringe. This allows the sharp needle to be quarantined and disposed of separate from the syringe. There is debate around the use of these devices as they involved in additional step in the handling of sharps waste.\n\nIn the developing world \nSharps waste is of great concern in developing and transitional regions of the world. Factors such as high disease prevalence and lack of health care professionals amplify the dangers involved with sharps waste, and the cost of newer disposal technology makes them unlikely to be used. \nAs with the rest of the world injection wastes make up the largest portion of sharps waste. However, injection use is much more prevalent in this world segment. One of the contributors to this increase is a larger emphasis placed on injections for therapeutic purposes. It has been estimated that 95% of all injections in developing regions are for therapeutic purposes.[4] The average person has been estimated to receive up to 8.5 injections per year.[4] Newly developed injection technologies are rarely used to provide these injections due to added costs. Therefore, the majority of injections are given with standard disposable syringes in developing regions.[5]\nThe infrastructure of developing regions is not equipped to deal with this large volume of contaminated sharps waste. Contrary to the industrialized world, disposal incinerators and transportation networks are not always available. Cost restraints make the purchase of single use disposable containers unrealistic. Facilities are often overwhelmed with patients and understaffed with educated workers. Demand on these facilities can limit the emphasis or enforcement of waste disposal protocols. These factors leave a dangerous quantity of sharps waste in the environment. Contrasts between the industrialized and developing world segment can be seen in accidental needle stick injuries. These occur at a rate of .18 to .74 per person per year in industrialized nations and .93 to 4.68 per person per year in developing and transitional nations (Hutin, Hauri, Armstrong, 2003).[citation needed ]\nImproper sharps management is a major factor involved in what is categorized as unsafe injections. Annually these account for 21 million, 2 million, and 260,000 of new HBV, HCV, and HIV infections annually.[6] 40-65% of new HBV and HCV are due to percutaneous occupational exposure.[7]\n\nFurther reading \nInnovation, diffusion and safety of a medical technology: a review of the literature on injection practices.[8]\nReferences \n\n\n^ URL=https:\/\/www.cdc.gov\/niosh\/stopsticks\/sharpsdisposal.html. Title= \"Stop Sticks Campaign\". Publisher= NIOSH. date of access= 17. September 17 \n\n^ WHO Archived 2006-05-25 at the Wayback Machine. World Health Organization (2004). Proposed agenda to evaluate the risks and benefits associated with using needle-removing devices. Switzerland. \n\n^ Jagger, J., De Carli, G., Perry, J., Puro, V., Ippolito, G. (2003). Chapter 31: Occupational Exposure to Bloodborne Pathogens: Epidemiology and Prevention. Prevention and Control of Nosocomial Infections (4th Ed). Lippincott, Williams, and Wilkins. \n\n^ a b Simonsen, L. Kane, A. Lloyd, J. Zaffran, M. Kane, M (1999). Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bulletin of the World Health Organization, 77(10). \n\n^ Needle Remover Harner, C. (2004, October). Needle Remover Device Design Transfer Package. Retrieved September 7, 2005. \n\n^ Dziekan G, Chisolm D, Johns B, Rovira J, Hutin Y (2003). The cost-effectiveness of policies for the safe and appropriate use of injection in healthcare settings. Bulletin of the World Health Organization, 81(4) \n\n^ Pruss-Ustun A, Rapiti E, Hutin Y (2003). Sharps injuries: global burden of disease from sharps injuries to health-care workers. Geneva. World Health Organization, (WHO Environmental Burden of Disease Series, No. 3). \n\n^ Kotwal, Atul (March 2005). \"Innovation, diffusion and safety of a medical technology: a review of the literature on injection practices\". Social Science & Medicine. 60 (5): 1133\u20131147. doi:10.1016\/j.socscimed.2004.06.044. \n\n\nExternal links \nEPA Recommended Needle Disposal Options for Self Injectors\nWHO Health Care Waste Management\nvteBiosolids, waste, and waste managementMajor types\nAgricultural wastewater\nBiodegradable waste\nBiomedical waste\nBrown waste\nChemical waste\nConstruction waste\nDemolition waste\nElectronic waste\nby country\nFood waste\nGreen waste\nHazardous waste\nHeat waste\nIndustrial waste\nLitter\nMarine debris\nMining waste\nMunicipal solid waste\nOpen defecation\nPost-consumer waste\nRadioactive waste\nScrap metal\nSewage\nToxic waste\nWastewater\nProcesses\nAnaerobic digestion\nBiodegradation\nComposting\nGarden waste dumping\nIllegal dumping\nIncineration\nLandfill\nLandfill mining\nMechanical biological treatment\nMechanical sorting\nOpen dump\nPhotodegradation\nRecycling\nResource recovery\nSewage treatment\nWaste collection\nWaste picking\nWaste sorting\nWaste trade\nWaste treatment\nWaste-to-energy\nCountries\nArmenia\nBangladesh\nBrazil\nHong Kong\nIndia\nKazakhstan\nNew Zealand\nRussia\nSwitzerland\nTaiwan\nThailand\nTurkey\nUK\nUS\nAgreements\nBamako Convention\nBasel Convention\nEU directives\nbatteries\nframework\nincineration\nlandfills\nRoHS\nvehicles\nwaste water\nWEEE\nLondon Convention\nOslo Convention\nOSPAR Convention\nOther topics\nBlue Ribbon Commission on America's Nuclear Future\nCleaner production\nDowncycling\nEco-industrial park\nExtended producer responsibility\nHigh-level radioactive waste management\nHistory of waste management\nLandfill fire\nSewage regulation and administration\nUpcycling\nWaste hierarchy\nWaste legislation\nWaste minimisation\nZero waste\n\n Waste portal\n Environment portal\n Category\n Commons\nConcepts\nIndex\nJournals\nLists\nOrganizations\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a 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class=\"firstHeading\" lang=\"en\">Sharps waste<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Improperly_Discarded_%E2%80%98Sharps%E2%80%99_Can_Be_Dangerous_(6321875537).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/37\/Improperly_Discarded_%E2%80%98Sharps%E2%80%99_Can_Be_Dangerous_%286321875537%29.jpg\/220px-Improperly_Discarded_%E2%80%98Sharps%E2%80%99_Can_Be_Dangerous_%286321875537%29.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Improperly_Discarded_%E2%80%98Sharps%E2%80%99_Can_Be_Dangerous_(6321875537).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Sharps \u2013 like needles, syringes, lancets and other devices used at home to treat diabetes, arthritis, cancer, and other diseases \u2013 should be immediately disposed-of after use<\/div><\/div><\/div>\n<p><b>Sharps waste<\/b> is a form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical_waste\" title=\"Biomedical waste\" rel=\"external_link\" target=\"_blank\">biomedical waste<\/a> composed of used \"sharps\", which includes any device or object used to puncture or lacerate the skin. Sharps waste is classified as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_hazard\" title=\"Biological hazard\" rel=\"external_link\" target=\"_blank\">biohazardous<\/a> waste and must be carefully handled. Common medical materials treated as sharps waste are:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypodermic_needles\" class=\"mw-redirect\" title=\"Hypodermic needles\" rel=\"external_link\" target=\"_blank\">Hypodermic needles<\/a><\/li>\n<li>Disposable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpel\" title=\"Scalpel\" rel=\"external_link\" target=\"_blank\">scalpels<\/a> and blades<\/li>\n<li>Contaminated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glass\" title=\"Glass\" rel=\"external_link\" target=\"_blank\">glass<\/a> and some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic\" title=\"Plastic\" rel=\"external_link\" target=\"_blank\">plastics<\/a><\/li><\/ul>\n\n<h2><span class=\"mw-headline\" id=\"Qualifying_materials\">Qualifying materials<\/span><\/h2>\n<p>In addition to needles and blades, anything attached to them will also be considered sharps waste, such syringes and injection devices.\n<\/p><p>Blades can include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Razor\" title=\"Razor\" rel=\"external_link\" target=\"_blank\">razors<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpel\" title=\"Scalpel\" rel=\"external_link\" target=\"_blank\">scalpels<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-Acto_knife\" class=\"mw-redirect\" title=\"X-Acto knife\" rel=\"external_link\" target=\"_blank\">X-Acto knife<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scissors\" title=\"Scissors\" rel=\"external_link\" target=\"_blank\">scissors<\/a>, or any other medical items used for cutting in the medical setting, regardless of if they have been contaminated with biohazardous material. While glass and sharp plastic are considered sharps waste, their handling methods can vary.\n<\/p><p>Glass items which have been contaminated with a biohazardous material will be treated with the same concern as needles and blades, even if unbroken. If glass is contaminated, it is still often treated as a sharp, because it can break during the disposal process. Contaminated plastic items which are not sharp can be disposed of in a receptacle instead of a sharps container.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Dangers_involved\">Dangers involved<\/span><\/h2>\n<p>As a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_hazard\" title=\"Biological hazard\" rel=\"external_link\" target=\"_blank\">biohazardous<\/a> material, injuries from sharps waste can pose a large public health concern. By penetrating the skin, it is possible for this waste to spread blood-borne pathogens. The spread of these pathogens is directly responsible for the transmission of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood-borne_disease\" title=\"Blood-borne disease\" rel=\"external_link\" target=\"_blank\">blood-borne diseases<\/a>, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatitis_B\" title=\"Hepatitis B\" rel=\"external_link\" target=\"_blank\">hepatitis B<\/a> (HBV), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatitis_C\" title=\"Hepatitis C\" rel=\"external_link\" target=\"_blank\">hepatitis C<\/a> (HCV), and <a href=\"https:\/\/en.wikipedia.org\/wiki\/HIV\" title=\"HIV\" rel=\"external_link\" target=\"_blank\">HIV<\/a>. Health care professionals expose themselves to the risk of transmission of these diseases when handling sharps waste. The large volume handled by health care professionals on a daily basis increases the chance that an injury may occur.\n<\/p><p>The general public can occasionally be at risk to injuries from sharps waste as well when improperly disposed of by injection drug users.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Sharps_containers\">Sharps containers<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sharps_Container.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/34\/Sharps_Container.jpg\/220px-Sharps_Container.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sharps_Container.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"#sharps_containers\" rel=\"external_link\">sharps container<\/a> is specially designed for safe disposal of sharps waste.<\/div><\/div><\/div>\n<p>A <b>sharps container<\/b> is a hard <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_container\" title=\"Plastic container\" rel=\"external_link\" target=\"_blank\">plastic container<\/a> that is used to safely dispose of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypodermic_needle\" title=\"Hypodermic needle\" rel=\"external_link\" target=\"_blank\">hypodermic needles<\/a> and other sharp medical instruments, such as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy\" title=\"Intravenous therapy\" rel=\"external_link\" target=\"_blank\">IV<\/a> catheters and disposable scalpels. Sharps containers may be single use which are disposed of with the waste inside, or reusable which are robotically emptied and sterilized before being returned for re-use.\n<\/p><p>Needles are dropped into the container through an opening in the top. Needles should never be pushed or forced into the container, as damage to the container and\/or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Needlestick_injury\" title=\"Needlestick injury\" rel=\"external_link\" target=\"_blank\">needlestick injuries<\/a> may result. Sharps containers should not be filled above the indicated line, usually two-thirds full.\n<\/p><p>In North America, sharps containers are often red, and elsewhere are often yellow.\n<\/p><p>Airports and large institutions commonly have sharps containers available in restrooms for safe disposal for users of injection drugs, such as insulin-dependent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetic\" class=\"mw-redirect\" title=\"Diabetic\" rel=\"external_link\" target=\"_blank\">diabetics<\/a>. People injecting drugs in their homes may substitute other hard-sided containers such as empty milk jugs for disposal of needles.\n<\/p><p>Extreme care must be taken in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Waste_management\" title=\"Waste management\" rel=\"external_link\" target=\"_blank\">management<\/a> and disposal of sharps waste. The goal in sharps waste management is to safely handle all materials until they can be properly disposed. The final step in the disposal of sharps waste is to dispose of them in an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autoclave\" title=\"Autoclave\" rel=\"external_link\" target=\"_blank\">autoclave<\/a>. A less common approach is to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Incinerate\" class=\"mw-redirect\" title=\"Incinerate\" rel=\"external_link\" target=\"_blank\">incinerate<\/a> them; typically only <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemotherapy\" title=\"Chemotherapy\" rel=\"external_link\" target=\"_blank\">chemotherapy<\/a> sharps waste is incinerated. Steps must be taken along the way to minimize the risk of injury from this material, while maximizing the amount of sharps material disposed.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Health care workers are to minimize their interaction with sharps waste by disposing of it in a sealable container. Attempts by health care workers to disassemble sharps waste is kept to a minimum. Strict <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital\" title=\"Hospital\" rel=\"external_link\" target=\"_blank\">hospital<\/a> protocols and government regulations ensure that hospital workers handle sharps waste safely and dispose of it effectively.\n<\/p><p>Self-locking and sealable sharps containers are made of plastic so that the sharps can not easily penetrate through the sides. Such units are designed so that the whole container can be disposed of with other biohazardous waste. Single use <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sharps_container\" class=\"mw-redirect\" title=\"Sharps container\" rel=\"external_link\" target=\"_blank\">sharps containers<\/a> of various sizes are sold throughout the world. Large medical facilities may have their own 'mini' autoclave in which these sharps containers are disposed of with other medical wastes. This minimizes the distance the containers have to travel and the number of people to come in contact with the sharps waste. Smaller clinics or offices without such facilities are required by federal regulations to hire the services of a company that specializes in transporting and properly disposing of the hazardous wastes.\n<\/p><p>NIOSH found through results from focus groups that accommodation, functionality, accessibility, and visibility are four areas of high importance to be able to ensure safe discarding of sharps. The studies found it was important to have containers that are easy to use with little need for training to be able to use. The containers should be visible in any areas that sharps are used and be placed in such degree that spillage and injury will not be likely to occur with use.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Recent legislation in <a href=\"https:\/\/en.wikipedia.org\/wiki\/France\" title=\"France\" rel=\"external_link\" target=\"_blank\">France<\/a> has stated that pharmaceutical companies supplying self injection medications are responsible for the disposal of spent needles. Previously popular needle clippers and caps are no longer acceptable as safety devices and either sharps box or needle destruction devices are required.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Disposal methods vary by country and locale, but common methods of disposal are either by truck service or, in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a>, by disposal of sharps through the mail. Truck service involves trained personnel collecting sharps waste, and often <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_waste\" class=\"mw-redirect\" title=\"Medical waste\" rel=\"external_link\" target=\"_blank\">medical waste<\/a>, at the point of generation and hauling it away by truck to a destruction facility. Similarly, the mail-back sharps disposal method allows generators to ship sharps waste to the disposal facility directly through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Postal_Service\" title=\"United States Postal Service\" rel=\"external_link\" target=\"_blank\">U.S. mail<\/a> in specially designed and approved shipping containers. Mail-back sharps disposal allows waste generators to dispose of smaller amounts of sharps more economically than if they were to hire out a truck service.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Injection_technology\">Injection technology<\/span><\/h2>\n<p>With more than sixteen billion injections administered annually worldwide,<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> they are the largest contributor to sharps waste. For this reason many new technologies surrounding injections have been developed, mostly related to safety mechanisms. As these technologies have been developed governments have attempted to make them commonplace to ensure sharps waste safety. In 2000, the was passed, along with the 2001 .<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Safety_syringes\" class=\"mw-redirect\" title=\"Safety syringes\" rel=\"external_link\" target=\"_blank\">Safety syringes<\/a> help reduce occurrences of accidental needlesticks. One of the most recent developments has been the auto-disable injection device. These injection devices automatically disable after a single use. This can be done by retracting the needle back into the syringe or rendering the syringe plunger inoperable. With the injection device now inoperable, it cannot be reused. Shielding the needle after the injection is another approach for safe management of sharps. These are hands free methods usually involving a hinging cap that can be pressed on a table to seal the needle. Another technology in sharps waste management relating to injections is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Needle_remover\" class=\"mw-redirect\" title=\"Needle remover\" rel=\"external_link\" target=\"_blank\">needle remover<\/a>. Varying approaches can be taken with the main goal to separate the needle from the syringe. This allows the sharp needle to be quarantined and disposed of separate from the syringe. There is debate around the use of these devices as they involved in additional step in the handling of sharps waste.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"In_the_developing_world\">In the developing world<\/span><\/h2>\n<p>Sharps waste is of great concern in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Developing_world\" class=\"mw-redirect\" title=\"Developing world\" rel=\"external_link\" target=\"_blank\">developing<\/a> and transitional regions of the world. Factors such as high disease prevalence and lack of health care professionals amplify the dangers involved with sharps waste, and the cost of newer disposal technology makes them unlikely to be used. \nAs with the rest of the world injection wastes make up the largest portion of sharps waste. However, injection use is much more prevalent in this world segment. One of the contributors to this increase is a larger emphasis placed on injections for therapeutic purposes. It has been estimated that 95% of all injections in developing regions are for therapeutic purposes.<sup id=\"rdp-ebb-cite_ref-Simonsen_4-0\" class=\"reference\"><a href=\"#cite_note-Simonsen-4\" rel=\"external_link\">[4]<\/a><\/sup> The average person has been estimated to receive up to 8.5 injections per year.<sup id=\"rdp-ebb-cite_ref-Simonsen_4-1\" class=\"reference\"><a href=\"#cite_note-Simonsen-4\" rel=\"external_link\">[4]<\/a><\/sup> Newly developed injection technologies are rarely used to provide these injections due to added costs. Therefore, the majority of injections are given with standard disposable syringes in developing regions.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>The infrastructure of developing regions is not equipped to deal with this large volume of contaminated sharps waste. Contrary to the industrialized world, disposal incinerators and transportation networks are not always available. Cost restraints make the purchase of single use disposable containers unrealistic. Facilities are often overwhelmed with patients and understaffed with educated workers. Demand on these facilities can limit the emphasis or enforcement of waste disposal protocols. These factors leave a dangerous quantity of sharps waste in the environment. Contrasts between the industrialized and developing world segment can be seen in accidental needle stick injuries. These occur at a rate of .18 to .74 per person per year in industrialized nations and .93 to 4.68 per person per year in developing and transitional nations (Hutin, Hauri, Armstrong, 2003).<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Improper sharps management is a major factor involved in what is categorized as unsafe injections. Annually these account for 21 million, 2 million, and 260,000 of new HBV, HCV, and HIV infections annually.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> 40-65% of new HBV and HCV are due to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous\" title=\"Percutaneous\" rel=\"external_link\" target=\"_blank\">percutaneous<\/a> occupational exposure.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li>Innovation, diffusion and safety of a medical technology: a review of the literature on injection practices.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">URL=<a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.cdc.gov\/niosh\/stopsticks\/sharpsdisposal.html\" target=\"_blank\">https:\/\/www.cdc.gov\/niosh\/stopsticks\/sharpsdisposal.html<\/a>. Title= \"Stop Sticks Campaign\". Publisher= NIOSH. date of access= 17. September 17<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.uqconnect.net\/signfiles\/Files\/ScopeOfWorkNeedleRemoversDraft5.pdf\" target=\"_blank\">WHO<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060525023731\/http:\/\/www.uqconnect.net\/signfiles\/Files\/ScopeOfWorkNeedleRemoversDraft5.pdf\" target=\"_blank\">Archived<\/a> 2006-05-25 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>. World Health Organization (2004). Proposed agenda to evaluate the risks and benefits associated with using needle-removing devices. Switzerland.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Jagger, J., De Carli, G., Perry, J., Puro, V., Ippolito, G. (2003). Chapter 31: Occupational Exposure to Bloodborne Pathogens: Epidemiology and Prevention. Prevention and Control of Nosocomial Infections (4th Ed). Lippincott, Williams, and Wilkins.<\/span>\n<\/li>\n<li id=\"cite_note-Simonsen-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Simonsen_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Simonsen_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Simonsen, L. Kane, A. Lloyd, J. Zaffran, M. Kane, M (1999). Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bulletin of the World Health Organization, 77(10).<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.healthcarewaste.org\/documents\/PATH_needleRemover_design.pdf\" target=\"_blank\">Needle Remover<\/a> Harner, C. (2004, October). Needle Remover Device Design Transfer Package. Retrieved September 7, 2005.<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Dziekan G, Chisolm D, Johns B, Rovira J, Hutin Y (2003). The cost-effectiveness of policies for the safe and appropriate use of injection in healthcare settings. Bulletin of the World Health Organization, 81(4)<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Pruss-Ustun A, Rapiti E, Hutin Y (2003). Sharps injuries: global burden of disease from sharps injuries to health-care workers. Geneva. World Health Organization, (WHO Environmental Burden of Disease Series, No. 3).<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kotwal, Atul (March 2005). \"Innovation, diffusion and safety of a medical technology: a review of the literature on injection practices\". <i>Social Science & Medicine<\/i>. <b>60<\/b> (5): 1133\u20131147. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.socscimed.2004.06.044\" target=\"_blank\">10.1016\/j.socscimed.2004.06.044<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Social+Science+%26+Medicine&rft.atitle=Innovation%2C+diffusion+and+safety+of+a+medical+technology%3A+a+review+of+the+literature+on+injection+practices&rft.volume=60&rft.issue=5&rft.pages=1133-1147&rft.date=2005-03&rft_id=info%3Adoi%2F10.1016%2Fj.socscimed.2004.06.044&rft.aulast=Kotwal&rft.aufirst=Atul&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASharps+waste\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.epa.gov\/waste\/nonhaz\/industrial\/medical\/med-home.pdf\" target=\"_blank\">EPA Recommended Needle Disposal Options for Self Injectors<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20051201192138\/http:\/\/www.healthcarewaste.org\/en\/115_overview.html\" target=\"_blank\">WHO Health Care Waste Management<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1274\nCached time: 20181207000901\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.216 seconds\nReal time usage: 0.307 seconds\nPreprocessor visited node count: 748\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 27405\/2097152 bytes\nTemplate argument size: 1542\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 6402\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.109\/10.000 seconds\nLua memory usage: 2.68 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 242.948 1 -total\n<\/p>\n<pre>46.34% 112.589 1 Template:Reflist\n35.71% 86.753 3 Template:Citation_needed\n33.98% 82.561 1 Template:Cite_journal\n27.49% 66.791 3 Template:Fix\n16.36% 39.745 6 Template:Category_handler\n15.22% 36.970 1 Template:Waste\n13.75% 33.414 1 Template:Navbox\n 9.26% 22.500 3 Template:Delink\n 4.87% 11.834 3 Template:Icon\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:3410731-1!canonical and timestamp 20181207000900 and revision id 864711756\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sharps_waste\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214714\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.164 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 156.752 1 - wikipedia:Sharps_waste\n100.00% 156.752 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8580-0!*!*!*!*!*!* and timestamp 20181217214714 and revision id 25008\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Sharps_waste\">https:\/\/www.limswiki.org\/index.php\/Sharps_waste<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","5afb8d61cafaef8f2b60892a52bd104d_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/37\/Improperly_Discarded_%E2%80%98Sharps%E2%80%99_Can_Be_Dangerous_%286321875537%29.jpg\/440px-Improperly_Discarded_%E2%80%98Sharps%E2%80%99_Can_Be_Dangerous_%286321875537%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/34\/Sharps_Container.jpg\/440px-Sharps_Container.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3a\/Bedrijfsafval.jpg\/240px-Bedrijfsafval.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4c\/Dumpster-non.JPG\/32px-Dumpster-non.JPG"],"5afb8d61cafaef8f2b60892a52bd104d_timestamp":1545083234,"1cf942a9b4d4ec535b38698628d663dc_type":"article","1cf942a9b4d4ec535b38698628d663dc_title":"Retained surgical instruments","1cf942a9b4d4ec535b38698628d663dc_url":"https:\/\/www.limswiki.org\/index.php\/Retained_surgical_instruments","1cf942a9b4d4ec535b38698628d663dc_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tRetained surgical instruments\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tA retained surgical instrument is any item inadvertently left behind in a patient\u2019s body in the course of surgery. There are few books about it and it is thought to be under reported.[1] As a preventable medical error, it occurs more frequently than \"wrong site\" surgery. The consequences of retained surgical tools include injury, repeated surgery, excess monetary cost, loss of hospital credibility and in some cases death of patient.[2][3][4]\n\nContents \n\n1 Mistakes and consequences \n\n1.1 Types of forgotten instruments \n1.2 Frequency \n1.3 Gossypiboma \n1.4 Consequences \n\n\n2 Contributing factors \n3 Retained Surgical Instruments and Unretrieved Device Fragments (UDF) \n4 Preventing incidents \n5 References \n\n\nMistakes and consequences \nIn any given typical surgery, an estimated 250\u2013300 surgical tools are used.[5] The number significantly increases to 600 when a larger surgery is performed, thus increasing the chance of the surgeon losing an instrument.[5]\n\nTypes of forgotten instruments \n SmartSponge system, an RFID system to aid doctors in tracking sponges and other surgical items during surgery\nThere are many different types of tools that have been left behind during a surgery. Common instruments are needles, knife blades, safety pins, scalpels, clamps, scissors, sponges, towels, and electrosurgical adapters. Also retained are tweezers, forceps, suction tips and tubes, scopes, ultrasound tissue disruptors, asepto bulbs,[6] cryotomes and cutting laser guides, and measuring devices. The single most common left behind object is a sponge.[7]\n\nFrequency \nThe estimate of how often this type of mistake happens is unclear. According to the U.S. Department of Health and Human Services, it is anywhere between 1 in 100 to 1 in 5000.[1] However a study done in 2008 reported to the Annals of Surgery that mistakes in tool and sponge counts happened in 12.5% of surgeries.[8] Additionally, the Patient Safety Monitor Alert, announced in 2003 that 1,500 tools were stitched into patients each year.[9] Khaled Sakhel, part of the Department of Obstetrics and Gynecology at the Eastern Virginia Medical School, reported that it is expected to occur at least once \u201cin every 1,000\u20131,500\u201d[6] stomach surgeries. \nAn exact count of how often this happens would be impossible to calculate. The Joint Commission on Accreditation for Healthcare Organization (JCAHO) stated that \u201cunintentionally retained foreign bod(ies) without major permanent loss of function\u201d[1] (qtd. in Gibbs) are not required to be reported. Nurses have been discouraged against reporting all errors because of the threat of malpractice and liability issues.[5] Estimates are \u201cundoubtedly low.\u201d[5]\n\nGossypiboma \nGossypiboma is the official name for a retained sponge\/towel after surgery. This word comes from the Latin word for cotton, gossypium, combined with the Swahili word for place of concealment, boma.[10] It is also commonly referred to as textilioma. This word combines textile, meaning cloth, and the suffix \u2013oma, which means growth or tumor.[10]\nA case of gossypiboma can be subtle and may not be discovered until months or even years after the surgery has been performed. In rare cases, a situation can be so severe that it is noticed immediately. Some of the ways gossypiboma can present itself are as a mass in the body or as a bowel tumor.[11] Immediately after surgery, a case of gossypiboma can commonly be mistaken for an abscess, especially when it is near a passage between organs (a \u2018fistula\u2019). In those cases where a sponge isn\u2019t discovered until much later, it may be impossible to tell the difference between gossypiboma and an \u2018intra-abdominal abscess\u2019.[10] This is because both cause air bubbles and \u201ccalcification of the cavity wall.\u201d[10] Gossypiboma is difficult to diagnose due to vague, inconsistent symptoms and images from x-rays that provide no solid evidence and unclear results. Because it is difficult to diagnose, emphasis has been put on the prevention of the mistake. The following techniques have been put into practice to prevent gossypiboma.\n\nRadiopaque marking: Before operation, sponges can be soaked through with \u2018radio-opaque marker\u2019. This allows a sponge to be easily seen on plain radiographs. When the markers are noticed, it can be assumed that it is revealing a retained sponge. A.P. Zbar, Surgical Directorate at Oldchurch and Harold Wood Hospitals stated \u201cthe diagnosis is easily made by plain abdominal radiography, when a radio-opaque marker is seen\u201d.[11] This method is flawed in that it doesn\u2019t work if the sponges have broken into smaller pieces over time.\nUltrasonography- Gossypiboma can be recognized with ultrasonography by \u201cthe presence of brightly echogenic wavy structures in a cystic mass showing posterior acoustic shadowing that changes in parallel with the direction of the ultrasound beam\u201d according to Zbar [11] and associates.\nComputerized Tomography (CT)- A surgical sponge on a CT will show air bubbles on soft tissue masses. The flaw with this technique is that gossypibomas are easily confused with abscesses.\nConsequences \nDangers of a tool or sponge left behind range anywhere from harmless to life-threatening. Surgical tools left in the body can puncture vital organs and blood vessels, causing internal bleeding. Sponges can fester inside a body, growing increasingly dangerous over time. Additional operations may be necessary, which can be costly and also take the surgical table away from other patients with more urgent needs. Michael Blum said \u201cThe incidents observed\u2026took an average of 13 minutes to resolve, a time lapse which can significantly impact the flow of a busy emergency or perioperative department.\u201d[8] Another danger is a sponge can be misdiagnosed, resulting in an unnecessary extreme surgery.[10] (see case study below) A radical surgery can be avoided by considering the possibility of a retained sponge or tool.[12]\n\nContributing factors \nMany studies have taken place to pinpoint the causes of tools being forgotten in hopes that they may be avoided in the future. It has been thought that the amount of blood lost in a surgery or the changing of nurses during the surgery would influence the risk of losing something, but studies do not support this. Human factors such as exhaustion, lack of tools necessary to aid in producing an accurate count, and a chaotic environment all have been seen to increase the risk of forgetting a tool.[13] These factors cannot be controlled and surgeons must learn to mitigate them.\nInaccurate counts are a main reason why tools can be left behind. Many cases of a retained instrument originally reported a correct sponge count when the patient was released.[1] An inaccurate count can occur when nurses are deprived of sleep, when the operation is particularly difficult, long, and mentally draining, when the operation is an emergency, or when there are unforeseen changes in the procedure. \nAn increased amount of chaos and distractions lead to a higher risk of a surgeon forgetting a tool. Mark Hulse from North Shore Medical Center said the following about surgery; \u201cIt\u2019s a process that\u2019s definitely subject to interruption and can be prone to errors. You\u2019re doing a hundred other things at the same time, and as much as you try to keep your attention on it [sponge counts] if the surgeon needs something, it\u2019s easy to get distracted.\u201d[8] Some aspects of surgery that can add to chaos are performing unforeseen changes in the procedure and undergoing emergency surgery.[14] Consequently, the emergency room is the place most likely to make mistakes.[15]\nStudies have shown having a high body mass index increases risk. Boston researchers found that a one-point increase in BMI related to a higher risk by 10%. The researchers suggest that \u201cthey [surgeons] chalk it up to more room in a patient in which to lose things.\u201d[16]\n\n Retained Surgical Instruments and Unretrieved Device Fragments (UDF) \nIn 2008, the US Food and Drug Administration (FDA) published a Public Health Notification advising on serious adverse events arising from fragments of medical devices left behind after surgical procedures, known as unretrieved device fragments (UDFs). The FDA's Centre for Devices and Radiological Health receives around 1000 adverse event reports each year relating to UDFs.[17][18] One major source of UDFs is from the failure of surgical instruments.[19]\nThere are many risks from UDFs. The FDA states:\n\"The adverse events reported include local tissue reaction, infection, perforation and obstruction of blood vessels, and death. Contributing factors may include biocompatibility of the device materials, location of the fragment, potential migration of the fragment, and patient anatomy. During MRI procedures, magnetic fields may cause metallic fragments to migrate, and radiofrequency fields may cause them to heat, causing internal tissue damage and\/or burns\"[19]\n\n<\/p>\nPreventing incidents \nImprovement in lowering the number of mistakes likely depends upon improving the surgical system, and not in individual scapegoating.[5] According to the Institute of Medicine, \u201cthe problem is not bad people; the problem is that the system needs to be made safer.\u201d[20]\nIn order to improve the system and reduce the number of accidents, some hospitals require four counts of sponges and instruments.[21] The first count happens when the instruments are being set up and the sponges unwrapped.[21] The next count is required right before surgery begins, another count as closure begins, and finally a count during skin closure.[21] This is a general guideline and there are different count methods according to different hospitals.[1]\nWhile careful counting could prevent some mistakes, counting carries its own risks. Sometimes the patient must be worked on immediately, leaving no time to count the instruments to be used beforehand. Another risk of counting after is having to leave the patient under anesthesia longer.[22] In addition, counting may not be entirely beneficial as counting is prone to human error and the majority of the cases of gossypiboma and other retained tools happen under a reported correct count.[8] Dr. Atul A. Gawande, a surgeon, said in an article published in The New England Journal of Medicine that \u201ceven though you're following procedures, the priority is the patient, not the procedures.\u201d[23]\nA new technique that is developing is similar to the Bar Code Medication Administration. The University of California at San Francisco and North Shore Medical Center have installed a \u201cbar coded sponge management system\u201d,[8] reasoning that technological error is smaller than human error.[8] Each surgical instrument has a bar code placed on it and nurses pass the items through a hand scanner. The bar code allows each sponge to be identified, resulting in little to no room for error. UCSF reported in April 2008 to have not had \"any unintended retained gauze or sponges\u201d since the installation of the system in April 2007.[8]\n\nReferences \n\n\n^ a b c d e Gibbs, Verna C. \u201cChapter 22. The Retained Surgical Sponge.\u201d \n\n^ \"General Instrument Sourcebook - KMedic\" (PDF) . Retrieved October 27, 2016 . \n\n^ \"Sterilized surgical instruments\". Archived from the original on October 27, 2016. Retrieved October 27, 2016 . \n\n^ Renee Nimitz, Surgical Instrumentation: an Interactive Approach (Saunders, 2010) 1416037020, pxiii \n\n^ a b c d e Institute of Medicine. To Err Is Human- Building a Safer Healthcare System pg.43 \n\n^ a b Sakhel, Khaled and James Hines. \u201cTo Forget is Human: the case of the retained bulb.\u201d Journal of Robotic Surgery pgs. 45\u201347 \n\n^ \u201cSurgical Instruments Left in Patient\u2019s Body.\u201d Nursing Link. \n\n^ a b c d e f g Gamble, Kate Huvane. \u201cNo Sponge Left Behind\u201d, Health Care Informatics. \n\n^ \"Emergencies, Procedure Changes Contribute to Left-Behind Surgical Instruments.\" Patient Safety Monitor Alert. \n\n^ a b c d e Fortia, Mohamed El, Maroua Bendaoud, and Sumer Sethi. \"Abdominal Gossypiboma (Textilioma).\" Internet Journal of Radiology \n\n^ a b c Zbar AP, A. Agrawal, I.T.Saeedi, and MRA Utidjian. \u201cGossypiboma revisited: a case report and review of the literature.\u201d \n\n^ Rajagopal, Ambil F.R.C.S. and Joseph Martin M.S. \u201cGossypiboma-\u201cA Surgeon\u2019s Legacy.\u201d Diseases of the Colon and Rectum \n\n^ \u201cEmergencies, Procedure Changes Contribute to Left-Behind Surgical Instruments.\u201d Patient Safety Monitor Alert. \n\n^ Gawande AA, et al. \u201cRisk Factors for Retained Instruments and Sponges After Surgery.\u201d N Engl J Med pg. 348 \n\n^ Institute of Medicine. To Err Is Human- Building a Safer Healthcare System. pg.37 \n\n^ Rasich, Paula. \u201cSurgical Tools.\u201d \n\n^ FDA. \"Unretrieved Device Fragments.\" \n\n^ Fischer, R. \"Danger: Beware of Unretrieved Device Fragments.\" \n\n^ a b Health Devices. \"Top 10 Technology Hazards.\" \n\n^ Institute of Medicine. To Err Is Human- Building a Safer Healthcare System. pg. 49 \n\n^ a b c Berguer, Ramon and Paul J. Heller. \"Preventing Sharps Injuries in the Operating Room.\" \n\n^ Smith, Carol. \u201cSurgical Tools Left in Five Patients.\u201d \n\n^ Grady, Denise. \u201cForgotten Surgical Tools 'Uncommon but Dangerous'.\u201d \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Retained_surgical_instruments\">https:\/\/www.limswiki.org\/index.php\/Retained_surgical_instruments<\/a>\n\t\t\t\t\tCategories: Healthcare termsMedical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 21:03.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 840 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","1cf942a9b4d4ec535b38698628d663dc_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Retained_surgical_instruments skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Retained surgical instruments<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>A <b>retained surgical instrument<\/b> is any item inadvertently left behind in a patient\u2019s body in the course of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a>. There are few books about it and it is thought to be under reported.<sup id=\"rdp-ebb-cite_ref-Gibbs_1-0\" class=\"reference\"><a href=\"#cite_note-Gibbs-1\" rel=\"external_link\">[1]<\/a><\/sup> As a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Preventable_medical_error\" class=\"mw-redirect\" title=\"Preventable medical error\" rel=\"external_link\" target=\"_blank\">preventable medical error<\/a>, it occurs more frequently than \"wrong site\" surgery. The consequences of retained surgical tools include injury, repeated surgery, excess monetary cost, loss of hospital credibility and in some cases death of patient.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Mistakes_and_consequences\">Mistakes and consequences<\/span><\/h2>\n<p>In any given typical surgery, an estimated 250\u2013300 surgical tools are used.<sup id=\"rdp-ebb-cite_ref-toerror_5-0\" class=\"reference\"><a href=\"#cite_note-toerror-5\" rel=\"external_link\">[5]<\/a><\/sup> The number significantly increases to 600 when a larger surgery is performed, thus increasing the chance of the surgeon losing an instrument.<sup id=\"rdp-ebb-cite_ref-toerror_5-1\" class=\"reference\"><a href=\"#cite_note-toerror-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Types_of_forgotten_instruments\">Types of forgotten instruments<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ssagh.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b3\/Ssagh.jpg\/220px-Ssagh.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ssagh.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>SmartSponge system, an <a href=\"https:\/\/en.wikipedia.org\/wiki\/RFID\" class=\"mw-redirect\" title=\"RFID\" rel=\"external_link\" target=\"_blank\">RFID<\/a> system to aid doctors in tracking sponges and other surgical items during surgery<\/div><\/div><\/div>\n<p>There are many different types of tools that have been left behind during a surgery. Common instruments are needles, knife blades, safety pins, scalpels, clamps, scissors, sponges, towels, and electrosurgical adapters. Also retained are tweezers, forceps, suction tips and tubes, scopes, ultrasound tissue disruptors, asepto bulbs,<sup id=\"rdp-ebb-cite_ref-Sakhel_6-0\" class=\"reference\"><a href=\"#cite_note-Sakhel-6\" rel=\"external_link\">[6]<\/a><\/sup> cryotomes and cutting laser guides, and measuring devices. The single most common left behind object is a sponge.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Frequency\">Frequency<\/span><\/h3>\n<p>The estimate of how often this type of mistake happens is unclear. According to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._Department_of_Health_and_Human_Services\" class=\"mw-redirect\" title=\"U.S. Department of Health and Human Services\" rel=\"external_link\" target=\"_blank\">U.S. Department of Health and Human Services<\/a>, it is anywhere between 1 in 100 to 1 in 5000.<sup id=\"rdp-ebb-cite_ref-Gibbs_1-1\" class=\"reference\"><a href=\"#cite_note-Gibbs-1\" rel=\"external_link\">[1]<\/a><\/sup> However a study done in 2008 reported to the <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Annals_of_Surgery\" title=\"Annals of Surgery\" rel=\"external_link\" target=\"_blank\">Annals of Surgery<\/a><\/i> that mistakes in tool and sponge counts happened in 12.5% of surgeries.<sup id=\"rdp-ebb-cite_ref-Gamble_8-0\" class=\"reference\"><a href=\"#cite_note-Gamble-8\" rel=\"external_link\">[8]<\/a><\/sup> Additionally, the <i>Patient Safety Monitor Alert<\/i>, announced in 2003 that 1,500 tools were stitched into patients each year.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> Khaled Sakhel, part of the Department of Obstetrics and Gynecology at the Eastern Virginia Medical School, reported that it is expected to occur at least once \u201cin every 1,000\u20131,500\u201d<sup id=\"rdp-ebb-cite_ref-Sakhel_6-1\" class=\"reference\"><a href=\"#cite_note-Sakhel-6\" rel=\"external_link\">[6]<\/a><\/sup> stomach surgeries. \nAn exact count of how often this happens would be impossible to calculate. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_Commission\" title=\"Joint Commission\" rel=\"external_link\" target=\"_blank\">Joint Commission<\/a> on Accreditation for Healthcare Organization (JCAHO) stated that \u201cunintentionally retained foreign bod(ies) without major permanent loss of function\u201d<sup id=\"rdp-ebb-cite_ref-Gibbs_1-2\" class=\"reference\"><a href=\"#cite_note-Gibbs-1\" rel=\"external_link\">[1]<\/a><\/sup> (qtd. in Gibbs) are not required to be reported. Nurses have been discouraged against reporting all errors because of the threat of malpractice and liability issues.<sup id=\"rdp-ebb-cite_ref-toerror_5-2\" class=\"reference\"><a href=\"#cite_note-toerror-5\" rel=\"external_link\">[5]<\/a><\/sup> Estimates are \u201cundoubtedly low.\u201d<sup id=\"rdp-ebb-cite_ref-toerror_5-3\" class=\"reference\"><a href=\"#cite_note-toerror-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Gossypiboma\">Gossypiboma<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gossypiboma\" title=\"Gossypiboma\" rel=\"external_link\" target=\"_blank\">Gossypiboma<\/a> is the official name for a retained sponge\/towel after surgery. This word comes from the Latin word for cotton, gossypium, combined with the Swahili word for place of concealment, boma.<sup id=\"rdp-ebb-cite_ref-fortia_10-0\" class=\"reference\"><a href=\"#cite_note-fortia-10\" rel=\"external_link\">[10]<\/a><\/sup> It is also commonly referred to as textilioma. This word combines textile, meaning cloth, and the suffix \u2013oma, which means growth or tumor.<sup id=\"rdp-ebb-cite_ref-fortia_10-1\" class=\"reference\"><a href=\"#cite_note-fortia-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>A case of gossypiboma can be subtle and may not be discovered until months or even years after the surgery has been performed. In rare cases, a situation can be so severe that it is noticed immediately. Some of the ways gossypiboma can present itself are as a mass in the body or as a bowel tumor.<sup id=\"rdp-ebb-cite_ref-zbar_11-0\" class=\"reference\"><a href=\"#cite_note-zbar-11\" rel=\"external_link\">[11]<\/a><\/sup> Immediately after surgery, a case of gossypiboma can commonly be mistaken for an abscess, especially when it is near a passage between organs (a \u2018fistula\u2019). In those cases where a sponge isn\u2019t discovered until much later, it may be impossible to tell the difference between gossypiboma and an \u2018intra-abdominal abscess\u2019.<sup id=\"rdp-ebb-cite_ref-fortia_10-2\" class=\"reference\"><a href=\"#cite_note-fortia-10\" rel=\"external_link\">[10]<\/a><\/sup> This is because both cause air bubbles and \u201ccalcification of the cavity wall.\u201d<sup id=\"rdp-ebb-cite_ref-fortia_10-3\" class=\"reference\"><a href=\"#cite_note-fortia-10\" rel=\"external_link\">[10]<\/a><\/sup> Gossypiboma is difficult to diagnose due to vague, inconsistent symptoms and images from x-rays that provide no solid evidence and unclear results. Because it is difficult to diagnose, emphasis has been put on the prevention of the mistake. The following techniques have been put into practice to prevent gossypiboma.\n<\/p>\n<ul><li>Radiopaque marking: Before operation, sponges can be soaked through with \u2018radio-opaque marker\u2019. This allows a sponge to be easily seen on plain radiographs. When the markers are noticed, it can be assumed that it is revealing a retained sponge. A.P. Zbar, Surgical Directorate at Oldchurch and Harold Wood Hospitals stated \u201cthe diagnosis is easily made by plain abdominal radiography, when a radio-opaque marker is seen\u201d.<sup id=\"rdp-ebb-cite_ref-zbar_11-1\" class=\"reference\"><a href=\"#cite_note-zbar-11\" rel=\"external_link\">[11]<\/a><\/sup> This method is flawed in that it doesn\u2019t work if the sponges have broken into smaller pieces over time.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasonography\" class=\"mw-redirect\" title=\"Ultrasonography\" rel=\"external_link\" target=\"_blank\">Ultrasonography<\/a>- Gossypiboma can be recognized with ultrasonography by \u201cthe presence of brightly echogenic wavy structures in a cystic mass showing posterior acoustic shadowing that changes in parallel with the direction of the ultrasound beam\u201d according to Zbar <sup id=\"rdp-ebb-cite_ref-zbar_11-2\" class=\"reference\"><a href=\"#cite_note-zbar-11\" rel=\"external_link\">[11]<\/a><\/sup> and associates.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computerized_Tomography\" class=\"mw-redirect\" title=\"Computerized Tomography\" rel=\"external_link\" target=\"_blank\">Computerized Tomography<\/a> (CT)- A surgical sponge on a CT will show air bubbles on soft tissue masses. The flaw with this technique is that gossypibomas are easily confused with abscesses.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Consequences\">Consequences<\/span><\/h3>\n<p>Dangers of a tool or sponge left behind range anywhere from harmless to life-threatening. Surgical tools left in the body can puncture vital organs and blood vessels, causing internal bleeding. Sponges can fester inside a body, growing increasingly dangerous over time. Additional operations may be necessary, which can be costly and also take the surgical table away from other patients with more urgent needs. Michael Blum said \u201cThe incidents observed\u2026took an average of 13 minutes to resolve, a time lapse which can significantly impact the flow of a busy emergency or perioperative department.\u201d<sup id=\"rdp-ebb-cite_ref-Gamble_8-1\" class=\"reference\"><a href=\"#cite_note-Gamble-8\" rel=\"external_link\">[8]<\/a><\/sup> Another danger is a sponge can be misdiagnosed, resulting in an unnecessary extreme surgery.<sup id=\"rdp-ebb-cite_ref-fortia_10-4\" class=\"reference\"><a href=\"#cite_note-fortia-10\" rel=\"external_link\">[10]<\/a><\/sup> (see case study below) A radical surgery can be avoided by considering the possibility of a retained sponge or tool.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Contributing_factors\">Contributing factors<\/span><\/h2>\n<p>Many studies have taken place to pinpoint the causes of tools being forgotten in hopes that they may be avoided in the future. It has been thought that the amount of blood lost in a surgery or the changing of nurses during the surgery would influence the risk of losing something, but studies do not support this. Human factors such as exhaustion, lack of tools necessary to aid in producing an accurate count, and a chaotic environment all have been seen to increase the risk of forgetting a tool.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> These factors cannot be controlled and surgeons must learn to mitigate them.\n<\/p><p>Inaccurate counts are a main reason why tools can be left behind. Many cases of a retained instrument originally reported a correct sponge count when the patient was released.<sup id=\"rdp-ebb-cite_ref-Gibbs_1-3\" class=\"reference\"><a href=\"#cite_note-Gibbs-1\" rel=\"external_link\">[1]<\/a><\/sup> An inaccurate count can occur when nurses are deprived of sleep, when the operation is particularly difficult, long, and mentally draining, when the operation is an emergency, or when there are unforeseen changes in the procedure. \n<\/p><p>An increased amount of chaos and distractions lead to a higher risk of a surgeon forgetting a tool. Mark Hulse from North Shore Medical Center said the following about surgery; \u201cIt\u2019s a process that\u2019s definitely subject to interruption and can be prone to errors. You\u2019re doing a hundred other things at the same time, and as much as you try to keep your attention on it [sponge counts] if the surgeon needs something, it\u2019s easy to get distracted.\u201d<sup id=\"rdp-ebb-cite_ref-Gamble_8-2\" class=\"reference\"><a href=\"#cite_note-Gamble-8\" rel=\"external_link\">[8]<\/a><\/sup> Some aspects of surgery that can add to chaos are performing unforeseen changes in the procedure and undergoing emergency surgery.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> Consequently, the emergency room is the place most likely to make mistakes.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p>Studies have shown having a high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_mass_index\" title=\"Body mass index\" rel=\"external_link\" target=\"_blank\">body mass index<\/a> increases risk. Boston researchers found that a one-point increase in BMI related to a higher risk by 10%. The researchers suggest that \u201cthey [surgeons] chalk it up to more room in a patient in which to lose things.\u201d<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h2><span id=\"rdp-ebb-Retained_Surgical_Instruments_and_Unretrieved_Device_Fragments_.28UDF.29\"><\/span><span class=\"mw-headline\" id=\"Retained_Surgical_Instruments_and_Unretrieved_Device_Fragments_(UDF)\">Retained Surgical Instruments and Unretrieved Device Fragments (UDF)<\/span><\/h2>\n<p>In 2008, the US Food and Drug Administration (FDA) published a Public Health Notification advising on serious adverse events arising from fragments of medical devices left behind after surgical procedures, known as unretrieved device fragments (UDFs). The FDA's Centre for Devices and Radiological Health receives around 1000 adverse event reports each year relating to UDFs.<sup id=\"rdp-ebb-cite_ref-FDA_17-0\" class=\"reference\"><a href=\"#cite_note-FDA-17\" rel=\"external_link\">[17]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Fischer_18-0\" class=\"reference\"><a href=\"#cite_note-Fischer-18\" rel=\"external_link\">[18]<\/a><\/sup> One major source of UDFs is from the failure of surgical instruments.<sup id=\"rdp-ebb-cite_ref-Health_Devices_19-0\" class=\"reference\"><a href=\"#cite_note-Health_Devices-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p><p>There are many risks from UDFs. The FDA states:\n<p>\"The adverse events reported include local tissue reaction, infection, perforation and obstruction of blood vessels, and death. Contributing factors may include biocompatibility of the device materials, location of the fragment, potential migration of the fragment, and patient anatomy. During MRI procedures, magnetic fields may cause metallic fragments to migrate, and radiofrequency fields may cause them to heat, causing internal tissue damage and\/or burns\"<sup id=\"rdp-ebb-cite_ref-Health_Devices_19-1\" class=\"reference\"><a href=\"#cite_note-Health_Devices-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Preventing_incidents\">Preventing incidents<\/span><\/h2>\n<p>Improvement in lowering the number of mistakes likely depends upon improving the surgical system, and not in individual scapegoating.<sup id=\"rdp-ebb-cite_ref-toerror_5-4\" class=\"reference\"><a href=\"#cite_note-toerror-5\" rel=\"external_link\">[5]<\/a><\/sup> According to the Institute of Medicine, \u201cthe problem is not bad people; the problem is that the system needs to be made safer.\u201d<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>In order to improve the system and reduce the number of accidents, some hospitals require four counts of sponges and instruments.<sup id=\"rdp-ebb-cite_ref-Berguer_21-0\" class=\"reference\"><a href=\"#cite_note-Berguer-21\" rel=\"external_link\">[21]<\/a><\/sup> The first count happens when the instruments are being set up and the sponges unwrapped.<sup id=\"rdp-ebb-cite_ref-Berguer_21-1\" class=\"reference\"><a href=\"#cite_note-Berguer-21\" rel=\"external_link\">[21]<\/a><\/sup> The next count is required right before surgery begins, another count as closure begins, and finally a count during skin closure.<sup id=\"rdp-ebb-cite_ref-Berguer_21-2\" class=\"reference\"><a href=\"#cite_note-Berguer-21\" rel=\"external_link\">[21]<\/a><\/sup> This is a general guideline and there are different count methods according to different hospitals.<sup id=\"rdp-ebb-cite_ref-Gibbs_1-4\" class=\"reference\"><a href=\"#cite_note-Gibbs-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>While careful counting could prevent some mistakes, counting carries its own risks. Sometimes the patient must be worked on immediately, leaving no time to count the instruments to be used beforehand. Another risk of counting after is having to leave the patient under anesthesia longer.<sup id=\"rdp-ebb-cite_ref-Smith_22-0\" class=\"reference\"><a href=\"#cite_note-Smith-22\" rel=\"external_link\">[22]<\/a><\/sup> In addition, counting may not be entirely beneficial as counting is prone to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_error\" title=\"Human error\" rel=\"external_link\" target=\"_blank\">human error<\/a> and the majority of the cases of gossypiboma and other retained tools happen under a reported correct count.<sup id=\"rdp-ebb-cite_ref-Gamble_8-3\" class=\"reference\"><a href=\"#cite_note-Gamble-8\" rel=\"external_link\">[8]<\/a><\/sup> Dr. Atul A. Gawande, a surgeon, said in an article published in <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_New_England_Journal_of_Medicine\" title=\"The New England Journal of Medicine\" rel=\"external_link\" target=\"_blank\">The New England Journal of Medicine<\/a><\/i> that \u201ceven though you're following procedures, the priority is the patient, not the procedures.\u201d<sup id=\"rdp-ebb-cite_ref-Grady_23-0\" class=\"reference\"><a href=\"#cite_note-Grady-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p><p>A new technique that is developing is similar to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bar_Code_Medication_Administration\" class=\"mw-redirect\" title=\"Bar Code Medication Administration\" rel=\"external_link\" target=\"_blank\">Bar Code Medication Administration<\/a>. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_California_at_San_Francisco\" class=\"mw-redirect\" title=\"University of California at San Francisco\" rel=\"external_link\" target=\"_blank\">University of California at San Francisco<\/a> and North Shore Medical Center have installed a \u201cbar coded sponge management system\u201d,<sup id=\"rdp-ebb-cite_ref-Gamble_8-4\" class=\"reference\"><a href=\"#cite_note-Gamble-8\" rel=\"external_link\">[8]<\/a><\/sup> reasoning that technological error is smaller than human error.<sup id=\"rdp-ebb-cite_ref-Gamble_8-5\" class=\"reference\"><a href=\"#cite_note-Gamble-8\" rel=\"external_link\">[8]<\/a><\/sup> Each surgical instrument has a bar code placed on it and nurses pass the items through a hand scanner. The bar code allows each sponge to be identified, resulting in little to no room for error. UCSF reported in April 2008 to have not had \"any unintended retained gauze or sponges\u201d since the installation of the system in April 2007.<sup id=\"rdp-ebb-cite_ref-Gamble_8-6\" class=\"reference\"><a href=\"#cite_note-Gamble-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-Gibbs-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Gibbs_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gibbs_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gibbs_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gibbs_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gibbs_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Gibbs, Verna C. \u201cChapter 22. The Retained Surgical Sponge.\u201d<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.teleflexmedicaloem.com\/pdf\/KMAD-4_General.pdf\" target=\"_blank\">\"General Instrument Sourcebook - KMedic\"<\/a> <span class=\"cs1-format\">(PDF)<\/span><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">October 27,<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=General+Instrument+Sourcebook+-+KMedic&rft_id=http%3A%2F%2Fwww.teleflexmedicaloem.com%2Fpdf%2FKMAD-4_General.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetained+surgical+instruments\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.vubu-medical.de\/\" target=\"_blank\">\"Sterilized surgical instruments\"<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.webcitation.org\/6lZHpXbVN\" target=\"_blank\">Archived<\/a> from the original on October 27, 2016<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">October 27,<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Sterilized+surgical+instruments&rft_id=https%3A%2F%2Fwww.vubu-medical.de%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetained+surgical+instruments\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Renee Nimitz, <i>Surgical Instrumentation: an Interactive Approach<\/i> (Saunders, 2010) 1416037020, pxiii<\/span>\n<\/li>\n<li id=\"cite_note-toerror-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-toerror_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-toerror_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-toerror_5-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-toerror_5-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-toerror_5-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Institute of Medicine. <i>To Err Is Human- Building a Safer Healthcare System<\/i> pg.43<\/span>\n<\/li>\n<li id=\"cite_note-Sakhel-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Sakhel_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Sakhel_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Sakhel, Khaled and James Hines. \u201cTo Forget is Human: the case of the retained bulb.\u201d <i>Journal of Robotic Surgery<\/i> pgs. 45\u201347<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\u201cSurgical Instruments Left in Patient\u2019s Body.\u201d <i>Nursing Link.<\/i><\/span>\n<\/li>\n<li id=\"cite_note-Gamble-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Gamble_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gamble_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gamble_8-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gamble_8-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gamble_8-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gamble_8-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Gamble_8-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Gamble, Kate Huvane. \u201cNo Sponge Left Behind\u201d, <i>Health Care Informatics<\/i>.<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"Emergencies, Procedure Changes Contribute to Left-Behind Surgical Instruments.\" <i>Patient Safety Monitor Alert<\/i>.<\/span>\n<\/li>\n<li id=\"cite_note-fortia-10\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-fortia_10-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fortia_10-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fortia_10-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fortia_10-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fortia_10-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Fortia, Mohamed El, Maroua Bendaoud, and Sumer Sethi. \"Abdominal Gossypiboma (Textilioma).\" <i>Internet Journal of Radiology<\/i><\/span>\n<\/li>\n<li id=\"cite_note-zbar-11\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-zbar_11-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-zbar_11-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-zbar_11-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Zbar AP, A. Agrawal, I.T.Saeedi, and MRA Utidjian. \u201cGossypiboma revisited: a case report and review of the literature.\u201d<\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Rajagopal, Ambil F.R.C.S. and Joseph Martin M.S. \u201cGossypiboma-\u201cA Surgeon\u2019s Legacy.\u201d <i>Diseases of the Colon and Rectum<\/i><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\u201cEmergencies, Procedure Changes Contribute to Left-Behind Surgical Instruments.\u201d <i>Patient Safety Monitor Alert.<\/i><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Gawande AA, et al. \u201cRisk Factors for Retained Instruments and Sponges After Surgery.\u201d <i>N Engl J Med<\/i> pg. 348<\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Institute of Medicine. <i>To Err Is Human- Building a Safer Healthcare System<\/i>. pg.37<\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Rasich, Paula. \u201cSurgical Tools.\u201d<\/span>\n<\/li>\n<li id=\"cite_note-FDA-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FDA_17-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">FDA. \"Unretrieved Device Fragments.\"<\/span>\n<\/li>\n<li id=\"cite_note-Fischer-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Fischer_18-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Fischer, R. \"Danger: Beware of Unretrieved Device Fragments.\"<\/span>\n<\/li>\n<li id=\"cite_note-Health_Devices-19\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Health_Devices_19-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Health_Devices_19-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Health Devices. \"Top 10 Technology Hazards.\"<\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Institute of Medicine. <i>To Err Is Human- Building a Safer Healthcare System.<\/i> pg. 49<\/span>\n<\/li>\n<li id=\"cite_note-Berguer-21\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Berguer_21-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Berguer_21-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Berguer_21-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Berguer, Ramon and Paul J. Heller. \"Preventing Sharps Injuries in the Operating Room.\"<\/span>\n<\/li>\n<li id=\"cite_note-Smith-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Smith_22-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Smith, Carol. \u201cSurgical Tools Left in Five Patients.\u201d<\/span>\n<\/li>\n<li id=\"cite_note-Grady-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Grady_23-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Grady, Denise. \u201cForgotten Surgical Tools 'Uncommon but Dangerous'.\u201d<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1325\nCached time: 20181216183732\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.160 seconds\nReal time usage: 0.184 seconds\nPreprocessor visited node count: 534\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 2831\/2097152 bytes\nTemplate argument size: 155\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 16057\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.057\/10.000 seconds\nLua memory usage: 1.47 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 123.580 1 Template:Reflist\n100.00% 123.580 1 -total\n<\/p>\n<pre>75.78% 93.644 2 Template:Cite_web\n 2.35% 2.904 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:25184288-1!canonical and timestamp 20181216183732 and revision id 857340463\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Retained_surgical_instruments\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214713\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.136 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 130.292 1 - wikipedia:Retained_surgical_instruments\n100.00% 130.292 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8579-0!*!*!*!*!*!* and timestamp 20181217214713 and revision id 25007\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Retained_surgical_instruments\">https:\/\/www.limswiki.org\/index.php\/Retained_surgical_instruments<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","1cf942a9b4d4ec535b38698628d663dc_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b3\/Ssagh.jpg\/440px-Ssagh.jpg"],"1cf942a9b4d4ec535b38698628d663dc_timestamp":1545083233,"7cc66603d9a9b5bb883b85a69555dc82_type":"article","7cc66603d9a9b5bb883b85a69555dc82_title":"Operating theater","7cc66603d9a9b5bb883b85a69555dc82_url":"https:\/\/www.limswiki.org\/index.php\/Operating_theater","7cc66603d9a9b5bb883b85a69555dc82_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tOperating theater\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (June 2017) (Learn how and when to remove this template message)\n Inside a modern operating room\nAn operating theater (also known as a good room, operating suite, theatre (British English), operation suite or OR) is a facility within a hospital where surgical operations are carried out in an aseptic environment.\nHistorically, the term \"operating theatre\" referred to a non-sterile, tiered theater or amphitheater in which students and other spectators could watch surgeons perform surgery. Contemporary operating rooms are devoid of a theatre setting, making the term \"operating theater\" a misnomer. There are only two old-style operating theaters left, both of which are preserved as part of museums.\n\nContents \n\n1 Operating rooms \n\n1.1 Operating room equipment \n\n\n2 Surgeon and assistants' equipment \n3 History \n\n3.1 Surviving operating theaters \n\n\n4 Popular culture \n5 See also \n6 References \n\n\nOperating rooms \nThis section does not cite any sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (October 2009) (Learn how and when to remove this template message)\nOperating rooms are spacious, easy to clean in a cleanroom, and well-lit, typically with overhead surgical lights, and may have viewing screens and monitors. Operating rooms are generally windowless and feature controlled temperature and humidity. Special air handlers filter the air and maintain a slightly elevated pressure. Electricity support has backup systems in case of a black-out. Rooms are supplied with wall suction, oxygen, and possibly other anesthetic gases. Key equipment consists of the operating table and the anesthesia cart. In addition, there are tables to set up instruments. There is storage space for common surgical supplies. There are containers for disposables. Outside the operating room is a dedicated scrubbing area that is used by surgeons, anesthetists, ODPs (operating department practitioners), and nurses prior to surgery. An operating room will have a map to enable the terminal cleaner to realign the operating table and equipment to the desired layout during cleaning.\nSeveral operating rooms are part of the operating suite that forms a distinct section within a health-care facility. Besides the operating rooms and their wash rooms, it contains rooms for personnel to change, wash, and rest, preparation and recovery rooms(s), storage and cleaning facilities, offices, dedicated corridors, and possibly other supportive units. In larger facilities, the operating suite is climate- and air-controlled, and separated from other departments so that only authorized personnel have access.\n\nOperating room equipment \n \nThe operating table in the center of the room can be raised, lowered, and tilted in any direction.\nThe operating room lights are over the table to provide bright light, without shadows, during surgery.\nThe anesthesia machine is at the head of the operating table. This machine has tubes that connect to the patient to assist him or her in breathing during surgery, and built-in monitors that help control the mixture of gases in the breathing circuit.\nThe anesthesia cart is next to the anesthesia machine. It contains the medications, equipment, and other supplies that the anesthesiologist may need.\nSterile instruments to be used during surgery are arranged on a stainless steel table.\nAn electronic monitor (which records the heart rate and respiratory rate by adhesive patches that are placed on the patient's chest).\nThe pulse oximeter machine attaches to the patient's finger with an elastic band aid. It measures the amount of oxygen contained in the blood.\n Hybrid operating room for cardiovascular surgery at Gemelli Hospital in Rome\nAutomated blood pressure measuring machine that automatically inflates the blood pressure cuff on patient's arm.\nAn electrocautery machine uses high frequency electrical signals to cauterize or seal off blood vessels and may also be used to cut through tissue with a minimal amount of bleeding.\nIf surgery requires, a Heart-lung machine, or other specialized equipment, may be brought into the room. Heart lung machine takes the temporary control of the heart and lung during the surgery maintaining the circulation of blood and oxygen content of the body\nAdvances in technology now support Hybrid Operating Rooms, which integrate diagnostic imaging systems such as MRI and Cardiac Catheterization into the operating room to assist surgeons in specialized Neurological and Cardiac procedures.\n Surgeon and assistants' equipment \nPeople in the operating room wear PPE (personal protective equipment) to help prevent bacteria from infecting the surgical incision. This PPE includes the following:\n\nSimilar to normal Cleanrooms, germless.\nA protective cap covering their hair\nMasks over their lower face, covering their mouths and noses with minimal gaps to prevent inhalation of plume or airborne microbes\nShades or glasses over their eyes, including specialized colored glasses for use with different lasers. a fiber-optic headlight may be attached for greater visibility\nSterile gloves; usually latex-free due to latex sensitivity which affects some health care workers and patients\nLong gowns, with the bottom of the gown no closer than six inches to the ground.\nProtective covers on their shoes\nIf x-rays are expected to be used, lead aprons\/neck covers are used to prevent overexposure to radiation\nThe surgeon may also wear special glasses that help him\/her to see more clearly. The circulating nurse and anesthesiologist will not wear a gown in the OR because they are not a part of the sterile team. They must keep a distance of 12-16 inches from any sterile object, person, or field.\n\nHistory \n The Agnew Clinic, 1889, by Thomas Eakins, showing the tiered arrangement of observers watching the operation.\n An operating room in the United States, c. 1960. Heart-Lung Machine with rotating disc oxygenator\nEarly operating theatres in an educational setting have had raised tables or chairs at the center for performing operations surrounded by several rows of seats for students and other spectators to observe the case in progress. The surgeons wore street clothes with an apron to protect them from blood stains, and they operated bare-handed with unsterilized instruments and supplies.[citation needed ]\nIn 1884 German surgeon Gustav Neuber implemented a comprehensive set of restrictions to ensure sterilization and aseptic operating conditions through the use of gowns, caps, and shoe covers, all of which were cleansed in his newly invented autoclave.[1] In 1885 he designed and built a private hospital in the woods where the walls, floors and hands, arms and faces of staff were washed with mercuric chloride, instruments were made with flat surfaces and the shelving was easy-to-clean glass. Neuber also introduced separate operating theaters for infected and uninfected patients and the use of heated and filtered air in the theater to eliminate germs.[2] In 1890 surgical gloves were introduced to the practice of medicine by William Halsted.[3] Aseptic surgery was pioneered in the United States by Charles McBurney.[4]\n\nSurviving operating theaters \n Old Operating Theatre in London\nOne of the oldest surviving operating theaters is the Old Operating Theatre in London. Built in 1822, it is now a museum of surgical history. Another theater still exists at the University of Padua, in Italy, inside Palazzo Bo. It was commissioned by the anatomist Girolamo Fabrizio d'Acquapendente in 1594. Another famous operating theater is the Ether Dome in Boston. Built in 1824, it is now a conference room and tourist attraction. Pennsylvania Hospital in Philadelphia also boasts its own surviving operating theater, built in 1804.[5]\n\nPopular culture \nIn the \"Homer's Triple Bypass\" episode of The Simpsons, Homer Simpson has an operation performed on him in an operating theater.\nIn Lemony Snicket's The Hostile Hospital, Count Olaf disguises his henchmen as doctors and tries to perform a \"cranioectomy\" (decapitation) on Violet Baudelaire for a live audience in an operating theater.\nMany scenes of the Cinemax series The Knick, set in the fictional Knickerbocker Hospital in New York City in 1900 and 1901, are set in the hospital's operating theatre, which has tiered seating surrounding the operating table from which other surgeons, students, or just interested spectators can watch the surgical procedures.\nIn The Terminal Man a large number of hospital staff watch an experimental epilepsy surgery being performed, while one of the spectators explains the procedure.\nIn the Seinfeld episode \"The Junior Mint,\" Jerry and Kramer witness a surgery being performed from the seats of an operating theater. The patient's health seems to take a turn for the worse after Jerry accidentally drops a Junior Mint candy from his seat into the patient's open chest cavity.\nSee also \nAnatomical theater\nHybrid operating room\nPatient identifier\nReferences \n\n\n^ Deysine, M (2003). Hernia infections: pathophysiology, diagnosis, treatment, prevention. Informa Health Care. pp. 13. ISBN 0-8247-4612-0. \n\n^ Bishop, WJ (1995). The Early history of surgery. Barnes & Noble. pp. 169. ISBN 1-56619-798-8. \n\n^ Porter, R (2001). The Cambridge illustrated history of medicine. Cambridge University Press. pp. 376. ISBN 0-521-00252-4. \n\n^ Gross, E (1990). This day in American history. Verlag f\u00fcr die Deutsche Wirtschaft. pp. 61. ISBN 1-55570-046-2. \n\n^ \"Pennsylvania Hospital History: Virtual Tour - Surgical Amphitheatre\". www.uphs.upenn.edu. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Operating_theater\">https:\/\/www.limswiki.org\/index.php\/Operating_theater<\/a>\n\t\t\t\t\tCategory: Healthcare settingsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 1 March 2016, at 18:09.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 806 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","7cc66603d9a9b5bb883b85a69555dc82_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Operating_theater skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Operating theater<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:292px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Operating_theatre.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e6\/Operating_theatre.jpg\/290px-Operating_theatre.jpg\" width=\"290\" height=\"218\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Operating_theatre.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Inside a modern operating room<\/div><\/div><\/div>\n<p>An <b>operating theater<\/b> (also known as a <b>good room<\/b>, <b>operating suite<\/b>, <b>theatre<\/b> (British English), <b>operation suite<\/b> or <b>OR<\/b>) is a facility within a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital\" title=\"Hospital\" rel=\"external_link\" target=\"_blank\">hospital<\/a> where surgical operations are carried out in an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Asepsis\" title=\"Asepsis\" rel=\"external_link\" target=\"_blank\">aseptic<\/a> environment.\n<\/p><p>Historically, the term \"operating theatre\" referred to a non-sterile, tiered <a href=\"https:\/\/en.wikipedia.org\/wiki\/Theater_(building)\" class=\"mw-redirect\" title=\"Theater (building)\" rel=\"external_link\" target=\"_blank\">theater<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amphitheater\" class=\"mw-redirect\" title=\"Amphitheater\" rel=\"external_link\" target=\"_blank\">amphitheater<\/a> in which students and other spectators could watch surgeons perform surgery. Contemporary operating rooms are devoid of a theatre setting, making the term \"operating theater\" a misnomer. There are only two old-style operating theaters left, both of which are preserved as part of museums.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Operating_rooms\">Operating rooms<\/span><\/h2>\n\n<p>Operating rooms are spacious, easy to clean in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cleanroom\" title=\"Cleanroom\" rel=\"external_link\" target=\"_blank\">cleanroom<\/a>, and well-lit, typically with overhead <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_lighting\" title=\"Surgical lighting\" rel=\"external_link\" target=\"_blank\">surgical lights<\/a>, and may have viewing screens and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_monitor\" class=\"mw-redirect\" title=\"Medical monitor\" rel=\"external_link\" target=\"_blank\">monitors<\/a>. Operating rooms are generally windowless and feature controlled temperature and humidity. Special air handlers filter the air and maintain a slightly elevated pressure. Electricity support has backup systems in case of a black-out. Rooms are supplied with wall suction, oxygen, and possibly other anesthetic gases. Key equipment consists of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Operating_table\" title=\"Operating table\" rel=\"external_link\" target=\"_blank\">operating table<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anesthesia_cart\" title=\"Anesthesia cart\" rel=\"external_link\" target=\"_blank\">anesthesia cart<\/a>. In addition, there are tables to set up instruments. There is storage space for common surgical supplies. There are containers for disposables. Outside the operating room is a dedicated scrubbing area that is used by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgeon\" title=\"Surgeon\" rel=\"external_link\" target=\"_blank\">surgeons<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anesthetist\" class=\"mw-redirect\" title=\"Anesthetist\" rel=\"external_link\" target=\"_blank\">anesthetists<\/a>, ODPs (operating department practitioners), and nurses prior to surgery. An operating room will have a map to enable the terminal cleaner to realign the operating table and equipment to the desired layout during cleaning.\n<\/p><p>Several operating rooms are part of the operating suite that forms a distinct section within a health-care facility. Besides the operating rooms and their wash rooms, it contains rooms for personnel to change, wash, and rest, preparation and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Recovery_room\" class=\"mw-redirect\" title=\"Recovery room\" rel=\"external_link\" target=\"_blank\">recovery rooms<\/a>(s), storage and cleaning facilities, offices, dedicated corridors, and possibly other supportive units. In larger facilities, the operating suite is climate- and air-controlled, and separated from other departments so that only authorized personnel have access.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Operating_room_equipment\">Operating room equipment<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sala_de_Cirurgia_Hospital_de_Est%C3%A2ncia.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Sala de Cirurgia Hospital de Est\u00e2ncia.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Sala_de_Cirurgia_Hospital_de_Est%C3%A2ncia.jpg\/220px-Sala_de_Cirurgia_Hospital_de_Est%C3%A2ncia.jpg\" width=\"220\" height=\"148\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sala_de_Cirurgia_Hospital_de_Est%C3%A2ncia.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><\/div><\/div><\/div>\n<ul><li>The operating table in the center of the room can be raised, lowered, and tilted in any direction.<\/li>\n<li>The operating room lights are over the table to provide bright light, without shadows, during surgery.<\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anesthesia_machine\" class=\"mw-redirect\" title=\"Anesthesia machine\" rel=\"external_link\" target=\"_blank\">anesthesia machine<\/a> is at the head of the operating table. This machine has tubes that connect to the patient to assist him or her in breathing during surgery, and built-in monitors that help control the mixture of gases in the breathing circuit.<\/li>\n<li>The anesthesia cart is next to the anesthesia machine. It contains the medications, equipment, and other supplies that the anesthesiologist may need.<\/li>\n<li>Sterile instruments to be used during surgery are arranged on a stainless steel table.<\/li>\n<li>An electronic monitor (which records the heart rate and respiratory rate by adhesive patches that are placed on the patient's chest).<\/li>\n<li>The pulse oximeter machine attaches to the patient's finger with an elastic band aid. It measures the amount of oxygen contained in the blood.<\/li><\/ul>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:402px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hybrid_operating_theatre_gemelli_rome.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/07\/Hybrid_operating_theatre_gemelli_rome.jpg\/400px-Hybrid_operating_theatre_gemelli_rome.jpg\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hybrid_operating_theatre_gemelli_rome.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hybrid_operating_room\" title=\"Hybrid operating room\" rel=\"external_link\" target=\"_blank\">Hybrid operating room<\/a> for cardiovascular surgery at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Agostino_Gemelli_University_Polyclinic\" title=\"Agostino Gemelli University Polyclinic\" rel=\"external_link\" target=\"_blank\">Gemelli Hospital<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rome\" title=\"Rome\" rel=\"external_link\" target=\"_blank\">Rome<\/a><\/div><\/div><\/div>\n<ul><li>Automated blood pressure measuring machine that automatically inflates the blood pressure cuff on patient's arm.<\/li>\n<li>An electrocautery machine uses high frequency electrical signals to cauterize or seal off blood vessels and may also be used to cut through tissue with a minimal amount of bleeding.<\/li>\n<li>If surgery requires, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart-lung_machine\" class=\"mw-redirect\" title=\"Heart-lung machine\" rel=\"external_link\" target=\"_blank\">Heart-lung machine<\/a>, or other specialized equipment, may be brought into the room. Heart lung machine takes the temporary control of the heart and lung during the surgery maintaining the circulation of blood and oxygen content of the body<\/li>\n<li>Advances in technology now support Hybrid Operating Rooms, which integrate diagnostic imaging systems such as MRI and Cardiac Catheterization into the operating room to assist surgeons in specialized Neurological and Cardiac procedures.<\/li><\/ul>\n<h2><span id=\"rdp-ebb-Surgeon_and_assistants.27_equipment\"><\/span><span class=\"mw-headline\" id=\"Surgeon_and_assistants'_equipment\">Surgeon and assistants' equipment<\/span><\/h2>\n<p>People in the operating room wear PPE (personal protective equipment) to help prevent bacteria from infecting the surgical incision. This PPE includes the following:\n<\/p>\n<ul><li>Similar to normal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cleanroom\" title=\"Cleanroom\" rel=\"external_link\" target=\"_blank\">Cleanrooms<\/a>, germless.<\/li>\n<li>A protective cap covering their hair<\/li>\n<li>Masks over their lower face, covering their mouths and noses with minimal gaps to prevent inhalation of plume or airborne microbes<\/li>\n<li>Shades or glasses over their eyes, including specialized colored glasses for use with different lasers. a fiber-optic headlight may be attached for greater visibility<\/li>\n<li>Sterile gloves; usually latex-free due to latex sensitivity which affects some health care workers and patients<\/li>\n<li>Long gowns, with the bottom of the gown no closer than six inches to the ground.<\/li>\n<li>Protective covers on their shoes<\/li>\n<li>If x-rays are expected to be used, lead aprons\/neck covers are used to prevent overexposure to radiation<\/li><\/ul>\n<p>The surgeon may also wear special glasses that help him\/her to see more clearly. The circulating nurse and anesthesiologist will not wear a gown in the OR because they are not a part of the sterile team. They must keep a distance of 12-16 inches from any sterile object, person, or field.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:The_Agnew_Clinic_-_Thomas_Eakins.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/21\/The_Agnew_Clinic_-_Thomas_Eakins.jpg\/220px-The_Agnew_Clinic_-_Thomas_Eakins.jpg\" width=\"220\" height=\"148\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:The_Agnew_Clinic_-_Thomas_Eakins.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Agnew_Clinic\" title=\"The Agnew Clinic\" rel=\"external_link\" target=\"_blank\">The Agnew Clinic<\/a><\/i>, 1889, by Thomas Eakins, showing the tiered arrangement of observers watching the operation.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hospital_Operating_Room_(FDA_042)_(8250274128).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/97\/Hospital_Operating_Room_%28FDA_042%29_%288250274128%29.jpg\/220px-Hospital_Operating_Room_%28FDA_042%29_%288250274128%29.jpg\" width=\"220\" height=\"281\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hospital_Operating_Room_(FDA_042)_(8250274128).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An operating room in the United States, c. 1960. Heart-Lung Machine with rotating disc oxygenator<\/div><\/div><\/div>\n<p>Early operating theatres in an educational setting have had raised tables or chairs at the center for performing operations surrounded by several rows of seats for students and other spectators to observe the case in progress. The surgeons wore street clothes with an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apron\" title=\"Apron\" rel=\"external_link\" target=\"_blank\">apron<\/a> to protect them from blood stains, and they operated bare-handed with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">unsterilized<\/a> instruments and supplies.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2009)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>In 1884 German surgeon <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gustav_Adolf_Neuber\" title=\"Gustav Adolf Neuber\" rel=\"external_link\" target=\"_blank\">Gustav Neuber<\/a> implemented a comprehensive set of restrictions to ensure sterilization and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Asepsis\" title=\"Asepsis\" rel=\"external_link\" target=\"_blank\">aseptic<\/a> operating conditions through the use of gowns, caps, and shoe covers, all of which were cleansed in his newly invented <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autoclave\" title=\"Autoclave\" rel=\"external_link\" target=\"_blank\">autoclave<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> In 1885 he designed and built a private hospital in the woods where the walls, floors and hands, arms and faces of staff were washed with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury(II)_chloride\" title=\"Mercury(II) chloride\" rel=\"external_link\" target=\"_blank\">mercuric chloride<\/a>, instruments were made with flat surfaces and the shelving was easy-to-clean glass. Neuber also introduced separate operating theaters for infected and uninfected patients and the use of heated and filtered air in the theater to eliminate germs.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> In 1890 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_glove\" title=\"Medical glove\" rel=\"external_link\" target=\"_blank\">surgical gloves<\/a> were introduced to the practice of medicine by <a href=\"https:\/\/en.wikipedia.org\/wiki\/William_Halsted\" class=\"mw-redirect\" title=\"William Halsted\" rel=\"external_link\" target=\"_blank\">William Halsted<\/a>.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> Aseptic surgery was pioneered in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a> by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charles_McBurney_(surgeon)\" title=\"Charles McBurney (surgeon)\" rel=\"external_link\" target=\"_blank\">Charles McBurney<\/a>.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Surviving_operating_theaters\">Surviving operating theaters<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Old_Operating_Theatre.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/74\/Old_Operating_Theatre.jpg\/220px-Old_Operating_Theatre.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Old_Operating_Theatre.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Old Operating Theatre in London<\/div><\/div><\/div>\n<p>One of the oldest surviving operating theaters is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Old_Operating_Theatre\" class=\"mw-redirect\" title=\"Old Operating Theatre\" rel=\"external_link\" target=\"_blank\">Old Operating Theatre<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/London\" title=\"London\" rel=\"external_link\" target=\"_blank\">London<\/a>. Built in 1822, it is now a museum of surgical history. Another theater still exists at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Padua\" title=\"University of Padua\" rel=\"external_link\" target=\"_blank\">University of Padua<\/a>, in Italy, inside Palazzo Bo. It was commissioned by the anatomist Girolamo Fabrizio d'Acquapendente in 1594. Another famous operating theater is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ether_Dome\" title=\"Ether Dome\" rel=\"external_link\" target=\"_blank\">Ether Dome<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Boston\" title=\"Boston\" rel=\"external_link\" target=\"_blank\">Boston<\/a>. Built in 1824, it is now a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Conference_hall\" title=\"Conference hall\" rel=\"external_link\" target=\"_blank\">conference room<\/a> and tourist attraction. Pennsylvania Hospital in Philadelphia also boasts its own surviving operating theater, built in 1804.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Popular_culture\">Popular culture<\/span><\/h2>\n<ul><li>In the \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Homer%27s_Triple_Bypass\" title=\"Homer's Triple Bypass\" rel=\"external_link\" target=\"_blank\">Homer's Triple Bypass<\/a>\" episode of <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Simpsons\" title=\"The Simpsons\" rel=\"external_link\" target=\"_blank\">The Simpsons<\/a><\/i>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Homer_Simpson\" title=\"Homer Simpson\" rel=\"external_link\" target=\"_blank\">Homer Simpson<\/a> has an operation performed on him in an operating theater.<\/li>\n<li>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lemony_Snicket\" title=\"Lemony Snicket\" rel=\"external_link\" target=\"_blank\">Lemony Snicket<\/a>'s <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Hostile_Hospital\" title=\"The Hostile Hospital\" rel=\"external_link\" target=\"_blank\">The Hostile Hospital<\/a><\/i>, Count Olaf disguises his henchmen as doctors and tries to perform a \"cranioectomy\" (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Decapitation\" title=\"Decapitation\" rel=\"external_link\" target=\"_blank\">decapitation<\/a>) on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Violet_Baudelaire\" class=\"mw-redirect\" title=\"Violet Baudelaire\" rel=\"external_link\" target=\"_blank\">Violet Baudelaire<\/a> for a live audience in an operating theater.<\/li>\n<li>Many scenes of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cinemax\" title=\"Cinemax\" rel=\"external_link\" target=\"_blank\">Cinemax<\/a> series <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Knick\" title=\"The Knick\" rel=\"external_link\" target=\"_blank\">The Knick<\/a><\/i>, set in the fictional Knickerbocker Hospital in New York City in 1900 and 1901, are set in the hospital's operating theatre, which has tiered seating surrounding the operating table from which other surgeons, students, or just interested spectators can watch the surgical procedures.<\/li>\n<li>In <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Terminal_Man_(film)\" title=\"The Terminal Man (film)\" rel=\"external_link\" target=\"_blank\">The Terminal Man<\/a><\/i> a large number of hospital staff watch an experimental <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epilepsy_surgery\" title=\"Epilepsy surgery\" rel=\"external_link\" target=\"_blank\">epilepsy surgery<\/a> being performed, while one of the spectators explains the procedure.<\/li>\n<li>In the <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Seinfeld\" title=\"Seinfeld\" rel=\"external_link\" target=\"_blank\">Seinfeld<\/a><\/i> episode \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Junior_Mint\" title=\"The Junior Mint\" rel=\"external_link\" target=\"_blank\">The Junior Mint<\/a>,\" Jerry and Kramer witness a surgery being performed from the seats of an operating theater. The patient's health seems to take a turn for the worse after Jerry accidentally drops a Junior Mint candy from his seat into the patient's open chest cavity.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatomical_theatre\" title=\"Anatomical theatre\" rel=\"external_link\" target=\"_blank\">Anatomical theater<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hybrid_operating_room\" title=\"Hybrid operating room\" rel=\"external_link\" target=\"_blank\">Hybrid operating room<\/a><\/li>\n<li>Patient <a href=\"https:\/\/en.wikipedia.org\/wiki\/Identifier\" title=\"Identifier\" rel=\"external_link\" target=\"_blank\">identifier<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Deysine, M (2003). <i>Hernia infections: pathophysiology, diagnosis, treatment, prevention<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Informa\" title=\"Informa\" rel=\"external_link\" target=\"_blank\">Informa Health Care<\/a>. pp. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=A7AzezHNMDUC&pg=PA13\" target=\"_blank\">13<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8247-4612-0.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Hernia+infections%3A+pathophysiology%2C+diagnosis%2C+treatment%2C+prevention&rft.pages=13&rft.pub=Informa+Health+Care&rft.date=2003&rft.isbn=0-8247-4612-0&rft.aulast=Deysine&rft.aufirst=M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOperating+theater\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Bishop, WJ (1995). <i>The Early history of surgery<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Barnes_%26_Noble\" title=\"Barnes & Noble\" rel=\"external_link\" target=\"_blank\">Barnes & Noble<\/a>. pp. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=Yds0EJ3nh8AC&pg=PA169\" target=\"_blank\">169<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-56619-798-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Early+history+of+surgery&rft.pages=169&rft.pub=Barnes+%26+Noble&rft.date=1995&rft.isbn=1-56619-798-8&rft.aulast=Bishop&rft.aufirst=WJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOperating+theater\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Porter, R (2001). <i>The Cambridge illustrated history of medicine<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cambridge_University_Press\" title=\"Cambridge University Press\" rel=\"external_link\" target=\"_blank\">Cambridge University Press<\/a>. pp. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=VsyYXczSmhgC&pg=PA376\" target=\"_blank\">376<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-521-00252-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Cambridge+illustrated+history+of+medicine&rft.pages=376&rft.pub=Cambridge+University+Press&rft.date=2001&rft.isbn=0-521-00252-4&rft.aulast=Porter&rft.aufirst=R&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOperating+theater\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Gross, E (1990). <i>This day in American history<\/i>. Verlag f\u00fcr die Deutsche Wirtschaft. pp. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=tQ9eEattl4MC&pg=PA61\" target=\"_blank\">61<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-55570-046-2.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=This+day+in+American+history&rft.pages=61&rft.pub=Verlag+f%C3%BCr+die+Deutsche+Wirtschaft&rft.date=1990&rft.isbn=1-55570-046-2&rft.aulast=Gross&rft.aufirst=E&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOperating+theater\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.uphs.upenn.edu\/paharc\/tour\/tour5.html\" target=\"_blank\">\"Pennsylvania Hospital History: Virtual Tour - Surgical Amphitheatre\"<\/a>. <i>www.uphs.upenn.edu<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.uphs.upenn.edu&rft.atitle=Pennsylvania+Hospital+History%3A+Virtual+Tour+-+Surgical+Amphitheatre&rft_id=http%3A%2F%2Fwww.uphs.upenn.edu%2Fpaharc%2Ftour%2Ftour5.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOperating+theater\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1330\nCached time: 20181210214724\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.168 seconds\nReal time usage: 0.247 seconds\nPreprocessor visited node count: 578\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 18956\/2097152 bytes\nTemplate argument size: 640\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 12901\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.078\/10.000 seconds\nLua memory usage: 2.6 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 188.125 1 -total\n<\/p>\n<pre>48.01% 90.313 1 Template:Reflist\n36.63% 68.914 4 Template:Cite_book\n30.19% 56.793 1 Template:Refimprove\n22.14% 41.659 2 Template:Ambox\n14.68% 27.621 1 Template:Citation_needed\n12.92% 24.305 1 Template:Fix\n 5.66% 10.648 2 Template:Category_handler\n 5.45% 10.246 1 Template:Unreferenced_section\n 5.18% 9.754 1 Template:Delink\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:384886-1!canonical and timestamp 20181210214724 and revision id 872934325\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Operating_theater\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214713\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.138 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 132.588 1 - wikipedia:Operating_theater\n100.00% 132.588 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8213-0!*!*!*!*!*!* and timestamp 20181217214713 and revision id 24363\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Operating_theater\">https:\/\/www.limswiki.org\/index.php\/Operating_theater<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","7cc66603d9a9b5bb883b85a69555dc82_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e6\/Operating_theatre.jpg\/580px-Operating_theatre.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Sala_de_Cirurgia_Hospital_de_Est%C3%A2ncia.jpg\/440px-Sala_de_Cirurgia_Hospital_de_Est%C3%A2ncia.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/07\/Hybrid_operating_theatre_gemelli_rome.jpg\/800px-Hybrid_operating_theatre_gemelli_rome.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/21\/The_Agnew_Clinic_-_Thomas_Eakins.jpg\/440px-The_Agnew_Clinic_-_Thomas_Eakins.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/97\/Hospital_Operating_Room_%28FDA_042%29_%288250274128%29.jpg\/440px-Hospital_Operating_Room_%28FDA_042%29_%288250274128%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/74\/Old_Operating_Theatre.jpg\/440px-Old_Operating_Theatre.jpg"],"7cc66603d9a9b5bb883b85a69555dc82_timestamp":1545083233,"01459832dca0b3aa9299ecec4ba67886_type":"article","01459832dca0b3aa9299ecec4ba67886_title":"MELISA","01459832dca0b3aa9299ecec4ba67886_url":"https:\/\/www.limswiki.org\/index.php\/MELISA","01459832dca0b3aa9299ecec4ba67886_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMELISA\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is about the blood test. For other uses, see Melisa (disambiguation).\nA MELISA (Memory Lymphocyte Immunostimulation Assay) test is a blood test that detects type IV hypersensitivity to metals, chemicals, environmental toxins and molds from one single blood sample. The test does not measure toxicity \u2013 that is to say, it will not measure the amounts of a harmful substance in the patient's blood. It measures if the patient is allergic to it.\nTwo articles have concluded that the MELISA test is not useful for diagnosis since a large number of false positive results will be obtained.[1][2] A subsequent study confirmed MELISA as reproducible, sensitive, specific, and reliable for detecting metal sensitivity in metal-sensitive patients.[3]\n\nContents \n\n1 Mechanism \n2 Applications \n\n2.1 Occupational medicine \n2.2 Dentistry \n2.3 Chronic diseases \n\n\n3 Validity \n4 See also \n5 References \n\n\nMechanism \nA MELISA test measures a so-called type-IV delayed hypersensitivity reaction. In contrast to a type-I allergy, which is mediated by IgE antibodies and is often tested using an ELISA test, a type-IV hypersensitivity reaction is mediated by T-lymphocytes (or memory lymphocytes) that have had prior contact with a given allergen.[4] In genetically predisposed individuals, an ongoing everyday exposure to allergens can induce the type-IV hypersensitivity with a resulting allergic reaction.[5]\nThe test procedure is a cell culture and requires live memory lymphocytes. Lymphocytes are isolated and cultured in an incubator for five days. A portion of the blood is kept intact (unexposed to allergens) to serve as a negative control. A second portion is exposed to a universal allergen, such as Pokeweed, to serve as a positive control. Finally, the third portion of the blood is exposed to the suspected allergen in several different concentrations, to ensure that the conditions in vitro are as similar as possible to the ones in vivo.\nAs an example, if a patient has a suspected allergy to dental amalgams, then the allergens tested for will be the metals most commonly used in dental amalgams, such as mercury, silver, tin, and copper.[6][7][8] If a patient has a suspected contact allergy to nickel then the test can be used to test for nickel allergy.[9] This is especially useful in individuals who have clinical symptoms (contact dermatitis) but a negative patch test.[10][11] The lymphocyte reaction to such an allergen is measured by two separate technologies: one based on the uptake of a radioactive isotope by dividing lymphocytes (proliferation); the other by classical microscopy evaluation (transformation). The level of reactivity is measured as a Stimulation Index (SI), against the na\u00efve lymphocytes from the unexposed sample (negative control). Viability and reactivity is determined by cell count as well as reaction to the positive control.[12][13]\n\nApplications \nOccupational medicine \nThe MELISA test is used in occupational medicine and environmental health. It has been used to screen workers exposed to metals, chemicals or other allergens in their workplace. This is what the test was developed for originally, at the Astra (now Astra-Zeneca) laboratories in Stockholm, Sweden. In the U.S., a similar technique (LTT) is routinely used to screen for Beryllium allergy in asymptomatic workers exposed to Beryllium dust.[14][15] Other occupations that use sensitivity testing include construction work, mining, electrical work, rubber\/wood\/ paper\/textile industry work, dentistry, hairdressing, and painting.[16] The MELISA test is used to screen, diagnose and monitor the immune response of susceptible or affected individuals.\n\nDentistry \nIn Europe, the test is commonly used in dentistry to test for allergy to dental restorative materials, braces and prostheses.[13]\n\nChronic diseases \nThe test is also used to determine whether metal allergy is a factor behind chronic diseases such as chronic fatigue syndrome[17] and multiple sclerosis.[18] The authors hypothesize that if the immune system is constantly staging an allergic reaction to a metal present in the body, this will alert the HPA axis inducing fatigue-like symptoms. A study[19] of 930 fatigue patients showed 62% testing MELISA-positive to metal allergy. Of those who removed the offending metals, 76% improved, but there was no placebo control. Metal allergy is not recognized by scientists as an accepted cause of chronic fatigue syndrome or multiple sclerosis.\n\nValidity \nTo test whether patients with symptoms attributed to dental amalgam differed from healthy controls, a study compared 23 amalgam patients, 30 healthy blood donors with amalgam and 10 healthy subjects without amalgam using MELISA and other tests. The researchers found that a high frequency of positive results was obtained among healthy subjects with or without dental amalgam, and concluded that the test cannot be used as an objective test for mercury allergy.[1]\nAnother study used 34 patients to test the sensitivity and specificity if the MELISA test, and concluded that it is not useful for diagnosis of contact allergy to the metals gold, palladium and nickel, since a large number of false-positive results will be obtained.[2]\nHowever, according to the MELISA Foundation the studies are flawed, mainly due to the incorrect selection of patients included as well as the use of patch test as a gold standard for the measurement of metal allergy.[20] The clinical relevance of the test has been shown by the decrease of patient-reported metal-specific responses following the removal of the allergy-causing metals (however the trial did not have a placebo control).[21][22]\n\nSee also \nhttp:\/\/www.melisa.org\nReferences \n\n\n^ a b Cederbrant K, Gunnarsson LG, Hultman P, Norda R, Tibbling-Grahn L (Aug 1999). \"In vitro lymphoproliferative assays with HgCl2 cannot identify patients with systemic symptoms attributed to dental amalgam\". J Dent Res. 78 (8): 1450\u20138. doi:10.1177\/00220345990780081101. PMID 10439033. \n\n^ a b Cederbrant K, Hultman P, Marcusson JA, Tibbling L (Mar 1997). \"In vitro lymphocyte proliferation as compared to patch test using gold, palladium and nickel\". Int Arch Allergy Immunol. 112 (3): 212\u20137. doi:10.1159\/000237456. PMID 9066505. \n\n^ Valentine-Thon E, Schiawara HW (February\u2013April 2003). \"Validity of MELISA for metal sensitivity testing\". Neuro Endocrinol Lett. 24 (1\u20132): 57\u201364. PMID 12743534. \n\n^ Stejskal VD, Forsbeck M, Nilsson R (June 1990). \"Lymphocyte transformation test for diagnosis of isothiazolinone allergy in man\". J Invest Dermatol. 94 (6): 798\u2013802. doi:10.1111\/1523-1747.ep12874656. PMID 1693940. \n\n^ Willis CM, Young E, Brandon DR, Wilkinson JD (September 1986). \"Immunopathological and ultrastructural findings in human allergic and irritant contact dermatitis\". Br J Dermatol. 115 (3): 305\u201316. doi:10.1111\/j.1365-2133.1986.tb05745.x. PMID 3530310. \n\n^ Silvennoinen-Kassinen S, Niinim\u00e4ki A (September 1984). \"Gold sensitivity blast transformation\". Contact Derm. 11 (3): 156\u20138. doi:10.1111\/j.1600-0536.1984.tb00962.x. PMID 6437738. \n\n^ Stejskal VD, Forsbeck M, Cederbrant KE, Asteman O (January 1996). \"Mercury-specific lymphocytes: an indication of mercury allergy in man\". J Clin Immunol. 16 (1): 31\u201340. doi:10.1007\/BF01540970. PMID 8926283. \n\n^ Marcusson JA (May 1996). \"Contact allergies to nickel sulfate, gold sodium thiosulfate and palladium chloride in patients claiming side-effects from dental alloy components\". Contact Derm. 34 (5): 320\u20133. doi:10.1111\/j.1600-0536.1996.tb02215.x. PMID 8807223. \n\n^ Everness KM, Gawkrodger DJ, Botham PA, Hunter JA (March 1990). \"The discrimination between nickel-sensitive and non-nickel-sensitive subjects by an in vitro lymphocyte transformation test\". Br J Dermatol. 122 (3): 293\u20138. doi:10.1111\/j.1365-2133.1990.tb08276.x. PMID 2322494. \n\n^ Klas PA, Corey G, Storrs FJ, Chan SC, Hanifin JM (February 1996). \"Allergic and irritant patch test reactions and atopic disease\". Contact Derm. 34 (2): 121\u20134. doi:10.1111\/j.1600-0536.1996.tb02143.x. PMID 8681540. \n\n^ Rietschel RL (May 1996). \"Reproducibility of patch-test results\". Lancet. 347 (9010): 1202. doi:10.1016\/S0140-6736(96)90731-X. PMID 8622447. \n\n^ Sachs B, Merk H (2001). \"Demonstration and characterization of drug-specific lymphocyte reactivity in drug allergies\". Allergy Clin Immunol Int: J World Allergy Org. 13 (3): 91\u20138. doi:10.1027\/0838-1925.13.3.91. Archived from the original on 2006-10-26. \n\n^ a b Stejskal VD, Cederbrant K, Lindvall A, Forsbeck M (1994). \"MELISA \u2013 an in vitro tool for the study of metal allergy\". Toxicol in Vitro. 8 (5): 991\u20131000. doi:10.1016\/0887-2333(94)90233-X. PMID 20693060. \n\n^ Mroz MM, Kreiss K, Lezotte DC, Campbell PA, Newman LS (July 1991). \"Reexamination of the blood lymphocyte transformation test in the diagnosis of chronic beryllium disease\". J Allergy Clin Immunol. 88 (1): 54\u201360. doi:10.1016\/0091-6749(91)90300-D. PMID 2071785. Archived from the original on 2014-08-15. \n\n^ Newman LS (October 1996). \"Significance of the blood beryllium lymphocyte proliferation test\". Environ. Health Perspect. 104 (Suppl 5): 953\u20136. doi:10.2307\/3433017. JSTOR 3433017. PMC 1469695 . PMID 8933041. \n\n^ Bach FH, Hirschhorn K (1964). \"Lymphocyte interaction: a potential histocompatibility test in vitro\". Science. 143 (3608): 813\u20134. doi:10.1126\/science.143.3608.813. PMID 14088078. \n\n^ Sterzl I, Proch\u00e1zkov\u00e1 J, Hrd\u00e1 P, B\u00e1rtov\u00e1 J, Matucha P, Stejskal VD (1999). \"Mercury and nickel allergy: risk factors in fatigue and autoimmunity\". Neuro Endocrinol Lett. 20 (3\u20134): 221\u20138. PMID 11462117. \n\n^ Stejskal VD, Danersund A, Lindvall A, et al. (1999). \"Metal-specific lymphocytes: biomarkers of sensitivity in man\". Neuro Endocrinol Lett. 20 (5): 289\u201398. PMID 11460087. \n\n^ Stejskal VD, Danersund A, Lindvall A, Hudecek R, Nordman V, Yaqob A, Mayer W, Bieger W, Lindh U (1999). \"Metal-specific lymphocytes: biomarkers of sensitivity in man\". Neuro Endocrinol Lett. 20 (5): 289\u2013298. PMID 11460087. \n\n^ http:\/\/www.melisa.org\/critique.php \n\n^ Stejskal V, Hudecek R, Stejskal J, Sterzl I (2006). \"Diagnosis and treatment of metal-induced side-effects\". Neuro Endocrinol Lett. 27 (Suppl 1): 7\u201316. PMID 17261999. \n\n^ Valentine-Thon E, M\u00fcller K, Guzzi G, Kreisel S, Ohnsorge P, Sandkamp M (2006). \"LTT-MELISA\u00ae is clinically relevant for detecting and monitoring metal sensitivity\". Neuro Endocrinol Lett. 27 (Suppl 1): 17\u201324. PMID 17261998. \n\n\nvteMedical tests used in immunology and for inflammation (CPT 86000\u201386849)ImmunologyImmunoprecipitation\nChromatin immunoprecipitation\nImmunodiffusion\nOuchterlony double immunodiffusion\nRadial immunodiffusion\nImmunoelectrophoresis\nCounterimmunoelectrophoresis\nImmunoassay\nELISA\nELISPOT\nEnzyme Multiplied Immunoassay Technique\nRAST test\nRadioimmunoassay\nRadiobinding assay\nImmunofluorescence\nAgglutination\nHemagglutination\/Hemagglutinin\nCoombs test\nLatex fixation test\nOther\nDiagnostic immunology\nNephelometry\nComplement fixation test\nImmunocytochemistry\nImmunohistochemistry\nDirect fluorescent antibody\nEpitope mapping\nSkin allergy test\nPatch test\nInflammation\nC-reactive protein\nProcalcitonin\nTotal complement activity\nMELISA\nComplete blood count\nlymphocyte count\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/MELISA\">https:\/\/www.limswiki.org\/index.php\/MELISA<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 21:02.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 344 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","01459832dca0b3aa9299ecec4ba67886_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-MELISA skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">MELISA<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about the blood test. For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Melisa_(disambiguation)\" class=\"mw-disambig\" title=\"Melisa (disambiguation)\" rel=\"external_link\" target=\"_blank\">Melisa (disambiguation)<\/a>.<\/div>\n<p>A <b>MELISA<\/b> (<b>Memory <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lymphocyte\" title=\"Lymphocyte\" rel=\"external_link\" target=\"_blank\">Lymphocyte<\/a> Immunostimulation <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assay\" title=\"Assay\" rel=\"external_link\" target=\"_blank\">Assay<\/a><\/b>) test is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_test\" title=\"Blood test\" rel=\"external_link\" target=\"_blank\">blood test<\/a> that detects <a href=\"https:\/\/en.wikipedia.org\/wiki\/Type_IV_hypersensitivity\" title=\"Type IV hypersensitivity\" rel=\"external_link\" target=\"_blank\">type IV hypersensitivity<\/a> to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal\" title=\"Metal\" rel=\"external_link\" target=\"_blank\">metals<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical\" class=\"mw-redirect\" title=\"Chemical\" rel=\"external_link\" target=\"_blank\">chemicals<\/a>, environmental toxins and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mold\" title=\"Mold\" rel=\"external_link\" target=\"_blank\">molds<\/a> from one single <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_sample\" class=\"mw-redirect\" title=\"Blood sample\" rel=\"external_link\" target=\"_blank\">blood sample<\/a>. The test does not measure <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxicity\" title=\"Toxicity\" rel=\"external_link\" target=\"_blank\">toxicity<\/a> \u2013 that is to say, it will not measure the amounts of a harmful substance in the patient's blood. It measures if the patient is allergic to it.\n<\/p><p>Two articles have concluded that the MELISA test is not useful for diagnosis since a large number of false positive results will be obtained.<sup id=\"rdp-ebb-cite_ref-Cederbrant1999_1-0\" class=\"reference\"><a href=\"#cite_note-Cederbrant1999-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Cederbrant1997_2-0\" class=\"reference\"><a href=\"#cite_note-Cederbrant1997-2\" rel=\"external_link\">[2]<\/a><\/sup> A subsequent study confirmed MELISA as reproducible, sensitive, specific, and reliable for detecting metal sensitivity in metal-sensitive patients.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Mechanism\">Mechanism<\/span><\/h2>\n<p>A MELISA test measures a so-called type-IV delayed hypersensitivity reaction. In contrast to a type-I allergy, which is mediated by IgE <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antibody\" title=\"Antibody\" rel=\"external_link\" target=\"_blank\">antibodies<\/a> and is often tested using an <a href=\"https:\/\/en.wikipedia.org\/wiki\/ELISA\" title=\"ELISA\" rel=\"external_link\" target=\"_blank\">ELISA<\/a> test, a type-IV hypersensitivity reaction is mediated by <a href=\"https:\/\/en.wikipedia.org\/wiki\/T-lymphocyte\" class=\"mw-redirect\" title=\"T-lymphocyte\" rel=\"external_link\" target=\"_blank\">T-lymphocytes<\/a> (or memory lymphocytes) that have had prior contact with a given <a href=\"https:\/\/en.wikipedia.org\/wiki\/Allergen\" title=\"Allergen\" rel=\"external_link\" target=\"_blank\">allergen<\/a>.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> In genetically predisposed individuals, an ongoing everyday exposure to allergens can induce the type-IV hypersensitivity with a resulting allergic reaction.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>The test procedure is a cell culture and requires live memory lymphocytes. Lymphocytes are isolated and cultured in an incubator for five days. A portion of the blood is kept intact (unexposed to allergens) to serve as a negative control. A second portion is exposed to a universal allergen, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pokeweed\" class=\"mw-redirect\" title=\"Pokeweed\" rel=\"external_link\" target=\"_blank\">Pokeweed<\/a>, to serve as a positive control. Finally, the third portion of the blood is exposed to the suspected allergen in several different concentrations, to ensure that the conditions in vitro are as similar as possible to the ones in vivo.\n<\/p><p>As an example, if a patient has a suspected allergy to dental <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amalgam_(dentistry)\" title=\"Amalgam (dentistry)\" rel=\"external_link\" target=\"_blank\">amalgams<\/a>, then the allergens tested for will be the metals most commonly used in dental amalgams, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mercury_(element)\" title=\"Mercury (element)\" rel=\"external_link\" target=\"_blank\">mercury<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silver\" title=\"Silver\" rel=\"external_link\" target=\"_blank\">silver<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tin\" title=\"Tin\" rel=\"external_link\" target=\"_blank\">tin<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copper\" title=\"Copper\" rel=\"external_link\" target=\"_blank\">copper<\/a>.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> If a patient has a suspected contact allergy to nickel then the test can be used to test for nickel allergy.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> This is especially useful in individuals who have clinical symptoms (contact dermatitis) but a negative patch test.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> The lymphocyte reaction to such an allergen is measured by two separate technologies: one based on the uptake of a radioactive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isotope\" title=\"Isotope\" rel=\"external_link\" target=\"_blank\">isotope<\/a> by dividing lymphocytes (proliferation); the other by classical microscopy evaluation (transformation). The level of reactivity is measured as a Stimulation Index (SI), against the na\u00efve lymphocytes from the unexposed sample (negative control). Viability and reactivity is determined by cell count as well as reaction to the positive control.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Stejskal92_13-0\" class=\"reference\"><a href=\"#cite_note-Stejskal92-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Occupational_medicine\">Occupational medicine<\/span><\/h3>\n<p>The MELISA test is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Occupational_safety_and_health\" title=\"Occupational safety and health\" rel=\"external_link\" target=\"_blank\">occupational medicine<\/a> and environmental health. It has been used to screen workers exposed to metals, chemicals or other allergens in their workplace. This is what the test was developed for originally, at the Astra (now Astra-Zeneca) laboratories in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stockholm\" title=\"Stockholm\" rel=\"external_link\" target=\"_blank\">Stockholm<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sweden\" title=\"Sweden\" rel=\"external_link\" target=\"_blank\">Sweden<\/a>. In the U.S., a similar technique (LTT) is routinely used to screen for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Beryllium\" title=\"Beryllium\" rel=\"external_link\" target=\"_blank\">Beryllium<\/a> allergy in asymptomatic workers exposed to Beryllium dust.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> Other occupations that use sensitivity testing include construction work, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mining\" title=\"Mining\" rel=\"external_link\" target=\"_blank\">mining<\/a>, electrical work, rubber\/wood\/ paper\/textile industry work, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentistry\" title=\"Dentistry\" rel=\"external_link\" target=\"_blank\">dentistry<\/a>, hairdressing, and painting.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> The MELISA test is used to screen, diagnose and monitor the immune response of susceptible or affected individuals.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Dentistry\">Dentistry<\/span><\/h3>\n<p>In Europe, the test is commonly used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentistry\" title=\"Dentistry\" rel=\"external_link\" target=\"_blank\">dentistry<\/a> to test for allergy to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_restorative_materials\" class=\"mw-redirect\" title=\"Dental restorative materials\" rel=\"external_link\" target=\"_blank\">dental restorative materials<\/a>, braces and prostheses.<sup id=\"rdp-ebb-cite_ref-Stejskal92_13-1\" class=\"reference\"><a href=\"#cite_note-Stejskal92-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Chronic_diseases\">Chronic diseases<\/span><\/h3>\n<p>The test is also used to determine whether metal allergy is a factor behind chronic diseases such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_fatigue_syndrome\" title=\"Chronic fatigue syndrome\" rel=\"external_link\" target=\"_blank\">chronic fatigue syndrome<\/a><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multiple_sclerosis\" title=\"Multiple sclerosis\" rel=\"external_link\" target=\"_blank\">multiple sclerosis<\/a>.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> The authors hypothesize that if the immune system is constantly staging an allergic reaction to a metal present in the body, this will alert the <a href=\"https:\/\/en.wikipedia.org\/wiki\/HPA_axis\" class=\"mw-redirect\" title=\"HPA axis\" rel=\"external_link\" target=\"_blank\">HPA axis<\/a> inducing fatigue-like symptoms. A study<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> of 930 fatigue patients showed 62% testing MELISA-positive to metal allergy. Of those who removed the offending metals, 76% improved, but there was no placebo control. Metal allergy is not recognized by scientists as an accepted cause of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_fatigue_syndrome\" title=\"Chronic fatigue syndrome\" rel=\"external_link\" target=\"_blank\">chronic fatigue syndrome<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multiple_sclerosis\" title=\"Multiple sclerosis\" rel=\"external_link\" target=\"_blank\">multiple sclerosis<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Validity\">Validity<\/span><\/h2>\n<p>To test whether patients with symptoms attributed to dental amalgam differed from healthy controls, a study compared 23 amalgam patients, 30 healthy blood donors with amalgam and 10 healthy subjects without amalgam using MELISA and other tests. The researchers found that a high frequency of positive results was obtained among healthy subjects with or without dental amalgam, and concluded that the test cannot be used as an objective test for mercury allergy.<sup id=\"rdp-ebb-cite_ref-Cederbrant1999_1-1\" class=\"reference\"><a href=\"#cite_note-Cederbrant1999-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Another study used 34 patients to test the sensitivity and specificity if the MELISA test, and concluded that it is not useful for diagnosis of contact allergy to the metals gold, palladium and nickel, since a large number of false-positive results will be obtained.<sup id=\"rdp-ebb-cite_ref-Cederbrant1997_2-1\" class=\"reference\"><a href=\"#cite_note-Cederbrant1997-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>However, according to the MELISA Foundation the studies are flawed, mainly due to the incorrect selection of patients included as well as the use of patch test as a gold standard for the measurement of metal allergy.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> The clinical relevance of the test has been shown by the decrease of patient-reported metal-specific responses following the removal of the allergy-causing metals (however the trial did not have a placebo control).<sup id=\"rdp-ebb-cite_ref-Stejskal2006_21-0\" class=\"reference\"><a href=\"#cite_note-Stejskal2006-21\" rel=\"external_link\">[21]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Valentine-Thon2006_22-0\" class=\"reference\"><a href=\"#cite_note-Valentine-Thon2006-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.melisa.org\" target=\"_blank\">http:\/\/www.melisa.org<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-Cederbrant1999-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Cederbrant1999_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Cederbrant1999_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cederbrant K, Gunnarsson LG, Hultman P, Norda R, Tibbling-Grahn L (Aug 1999). \"In vitro lymphoproliferative assays with HgCl2 cannot identify patients with systemic symptoms attributed to dental amalgam\". <i>J Dent Res<\/i>. <b>78<\/b> (8): 1450\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F00220345990780081101\" target=\"_blank\">10.1177\/00220345990780081101<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10439033\" target=\"_blank\">10439033<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Dent+Res&rft.atitle=In+vitro+lymphoproliferative+assays+with+HgCl2+cannot+identify+patients+with+systemic+symptoms+attributed+to+dental+amalgam&rft.volume=78&rft.issue=8&rft.pages=1450-8&rft.date=1999-08&rft_id=info%3Adoi%2F10.1177%2F00220345990780081101&rft_id=info%3Apmid%2F10439033&rft.aulast=Cederbrant&rft.aufirst=K&rft.au=Gunnarsson%2C+LG&rft.au=Hultman%2C+P&rft.au=Norda%2C+R&rft.au=Tibbling-Grahn%2C+L&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Cederbrant1997-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Cederbrant1997_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Cederbrant1997_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cederbrant K, Hultman P, Marcusson JA, Tibbling L (Mar 1997). \"In vitro lymphocyte proliferation as compared to patch test using gold, palladium and nickel\". <i>Int Arch Allergy Immunol<\/i>. <b>112<\/b> (3): 212\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000237456\" target=\"_blank\">10.1159\/000237456<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9066505\" target=\"_blank\">9066505<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Int+Arch+Allergy+Immunol&rft.atitle=In+vitro+lymphocyte+proliferation+as+compared+to+patch+test+using+gold%2C+palladium+and+nickel&rft.volume=112&rft.issue=3&rft.pages=212-7&rft.date=1997-03&rft_id=info%3Adoi%2F10.1159%2F000237456&rft_id=info%3Apmid%2F9066505&rft.aulast=Cederbrant&rft.aufirst=K&rft.au=Hultman%2C+P&rft.au=Marcusson%2C+JA&rft.au=Tibbling%2C+L&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Valentine-Thon E, Schiawara HW (February\u2013April 2003). \"Validity of MELISA for metal sensitivity testing\". <i>Neuro Endocrinol Lett<\/i>. <b>24<\/b> (1\u20132): 57\u201364. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12743534\" target=\"_blank\">12743534<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuro+Endocrinol+Lett.&rft.atitle=Validity+of+MELISA+for+metal+sensitivity+testing&rft.volume=24&rft.issue=1%E2%80%932&rft.pages=57-64&rft.date=2003-02%2F2003-04&rft_id=info%3Apmid%2F12743534&rft.aulast=Valentine-Thon&rft.aufirst=E&rft.au=Schiawara%2C+HW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stejskal VD, Forsbeck M, Nilsson R (June 1990). \"Lymphocyte transformation test for diagnosis of isothiazolinone allergy in man\". <i>J Invest Dermatol<\/i>. <b>94<\/b> (6): 798\u2013802. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2F1523-1747.ep12874656\" target=\"_blank\">10.1111\/1523-1747.ep12874656<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1693940\" target=\"_blank\">1693940<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Invest+Dermatol&rft.atitle=Lymphocyte+transformation+test+for+diagnosis+of+isothiazolinone+allergy+in+man&rft.volume=94&rft.issue=6&rft.pages=798-802&rft.date=1990-06&rft_id=info%3Adoi%2F10.1111%2F1523-1747.ep12874656&rft_id=info%3Apmid%2F1693940&rft.aulast=Stejskal&rft.aufirst=VD&rft.au=Forsbeck%2C+M&rft.au=Nilsson%2C+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Willis CM, Young E, Brandon DR, Wilkinson JD (September 1986). \"Immunopathological and ultrastructural findings in human allergic and irritant contact dermatitis\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Br_J_Dermatol\" class=\"mw-redirect\" title=\"Br J Dermatol\" rel=\"external_link\" target=\"_blank\">Br J Dermatol<\/a><\/i>. <b>115<\/b> (3): 305\u201316. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1365-2133.1986.tb05745.x\" target=\"_blank\">10.1111\/j.1365-2133.1986.tb05745.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3530310\" target=\"_blank\">3530310<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Br+J+Dermatol&rft.atitle=Immunopathological+and+ultrastructural+findings+in+human+allergic+and+irritant+contact+dermatitis&rft.volume=115&rft.issue=3&rft.pages=305-16&rft.date=1986-09&rft_id=info%3Adoi%2F10.1111%2Fj.1365-2133.1986.tb05745.x&rft_id=info%3Apmid%2F3530310&rft.aulast=Willis&rft.aufirst=CM&rft.au=Young%2C+E&rft.au=Brandon%2C+DR&rft.au=Wilkinson%2C+JD&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Silvennoinen-Kassinen S, Niinim\u00e4ki A (September 1984). \"Gold sensitivity blast transformation\". <i>Contact Derm<\/i>. <b>11<\/b> (3): 156\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1600-0536.1984.tb00962.x\" target=\"_blank\">10.1111\/j.1600-0536.1984.tb00962.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6437738\" target=\"_blank\">6437738<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Contact+Derm.&rft.atitle=Gold+sensitivity+blast+transformation&rft.volume=11&rft.issue=3&rft.pages=156-8&rft.date=1984-09&rft_id=info%3Adoi%2F10.1111%2Fj.1600-0536.1984.tb00962.x&rft_id=info%3Apmid%2F6437738&rft.aulast=Silvennoinen-Kassinen&rft.aufirst=S&rft.au=Niinim%C3%A4ki%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stejskal VD, Forsbeck M, Cederbrant KE, Asteman O (January 1996). \"Mercury-specific lymphocytes: an indication of mercury allergy in man\". <i>J Clin Immunol<\/i>. <b>16<\/b> (1): 31\u201340. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2FBF01540970\" target=\"_blank\">10.1007\/BF01540970<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8926283\" target=\"_blank\">8926283<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Clin+Immunol.&rft.atitle=Mercury-specific+lymphocytes%3A+an+indication+of+mercury+allergy+in+man&rft.volume=16&rft.issue=1&rft.pages=31-40&rft.date=1996-01&rft_id=info%3Adoi%2F10.1007%2FBF01540970&rft_id=info%3Apmid%2F8926283&rft.aulast=Stejskal&rft.aufirst=VD&rft.au=Forsbeck%2C+M&rft.au=Cederbrant%2C+KE&rft.au=Asteman%2C+O&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Marcusson JA (May 1996). \"Contact allergies to nickel sulfate, gold sodium thiosulfate and palladium chloride in patients claiming side-effects from dental alloy components\". <i>Contact Derm<\/i>. <b>34<\/b> (5): 320\u20133. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1600-0536.1996.tb02215.x\" target=\"_blank\">10.1111\/j.1600-0536.1996.tb02215.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8807223\" target=\"_blank\">8807223<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Contact+Derm.&rft.atitle=Contact+allergies+to+nickel+sulfate%2C+gold+sodium+thiosulfate+and+palladium+chloride+in+patients+claiming+side-effects+from+dental+alloy+components&rft.volume=34&rft.issue=5&rft.pages=320-3&rft.date=1996-05&rft_id=info%3Adoi%2F10.1111%2Fj.1600-0536.1996.tb02215.x&rft_id=info%3Apmid%2F8807223&rft.au=Marcusson+JA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Everness KM, Gawkrodger DJ, Botham PA, Hunter JA (March 1990). \"The discrimination between nickel-sensitive and non-nickel-sensitive subjects by an in vitro lymphocyte transformation test\". <i>Br J Dermatol<\/i>. <b>122<\/b> (3): 293\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1365-2133.1990.tb08276.x\" target=\"_blank\">10.1111\/j.1365-2133.1990.tb08276.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2322494\" target=\"_blank\">2322494<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Br+J+Dermatol&rft.atitle=The+discrimination+between+nickel-sensitive+and+non-nickel-sensitive+subjects+by+an+in+vitro+lymphocyte+transformation+test&rft.volume=122&rft.issue=3&rft.pages=293-8&rft.date=1990-03&rft_id=info%3Adoi%2F10.1111%2Fj.1365-2133.1990.tb08276.x&rft_id=info%3Apmid%2F2322494&rft.aulast=Everness&rft.aufirst=KM&rft.au=Gawkrodger%2C+DJ&rft.au=Botham%2C+PA&rft.au=Hunter%2C+JA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Klas PA, Corey G, Storrs FJ, Chan SC, Hanifin JM (February 1996). \"Allergic and irritant patch test reactions and atopic disease\". <i>Contact Derm<\/i>. <b>34<\/b> (2): 121\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1600-0536.1996.tb02143.x\" target=\"_blank\">10.1111\/j.1600-0536.1996.tb02143.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8681540\" target=\"_blank\">8681540<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Contact+Derm.&rft.atitle=Allergic+and+irritant+patch+test+reactions+and+atopic+disease&rft.volume=34&rft.issue=2&rft.pages=121-4&rft.date=1996-02&rft_id=info%3Adoi%2F10.1111%2Fj.1600-0536.1996.tb02143.x&rft_id=info%3Apmid%2F8681540&rft.aulast=Klas&rft.aufirst=PA&rft.au=Corey%2C+G&rft.au=Storrs%2C+FJ&rft.au=Chan%2C+SC&rft.au=Hanifin%2C+JM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rietschel RL (May 1996). \"Reproducibility of patch-test results\". <i>Lancet<\/i>. <b>347<\/b> (9010): 1202. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" 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rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sachs B, Merk H (2001). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20061026212549\/http:\/\/verlag.hanshuber.com\/ezm\/index.php?ezm=ACI&la=e&ShowAbstract=9428&IssueID=927\" target=\"_blank\">\"Demonstration and characterization of drug-specific lymphocyte reactivity in drug allergies\"<\/a>. <i>Allergy Clin Immunol Int: J World Allergy Org<\/i>. <b>13<\/b> (3): 91\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1027%2F0838-1925.13.3.91\" target=\"_blank\">10.1027\/0838-1925.13.3.91<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/verlag.hanshuber.com\/ezm\/index.php?ezm=ACI&la=e&ShowAbstract=9428&IssueID=927\" target=\"_blank\">the original<\/a> on 2006-10-26.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Allergy+Clin+Immunol+Int%3A+J+World+Allergy+Org.&rft.atitle=Demonstration+and+characterization+of+drug-specific+lymphocyte+reactivity+in+drug+allergies&rft.volume=13&rft.issue=3&rft.pages=91-8&rft.date=2001&rft_id=info%3Adoi%2F10.1027%2F0838-1925.13.3.91&rft.aulast=Sachs&rft.aufirst=B&rft.au=Merk%2C+H&rft_id=http%3A%2F%2Fverlag.hanshuber.com%2Fezm%2Findex.php%3Fezm%3DACI%26la%3De%26ShowAbstract%3D9428%26IssueID%3D927&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Stejskal92-13\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Stejskal92_13-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Stejskal92_13-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stejskal VD, Cederbrant K, Lindvall A, Forsbeck M (1994). \"MELISA \u2013 an in vitro tool for the study of metal allergy\". <i>Toxicol in Vitro<\/i>. <b>8<\/b> (5): 991\u20131000. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0887-2333%2894%2990233-X\" target=\"_blank\">10.1016\/0887-2333(94)90233-X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20693060\" target=\"_blank\">20693060<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Toxicol+in+Vitro&rft.atitle=MELISA+%E2%80%93+an+in+vitro+tool+for+the+study+of+metal+allergy&rft.volume=8&rft.issue=5&rft.pages=991-1000&rft.date=1994&rft_id=info%3Adoi%2F10.1016%2F0887-2333%2894%2990233-X&rft_id=info%3Apmid%2F20693060&rft.aulast=Stejskal&rft.aufirst=VD&rft.au=Cederbrant%2C+K&rft.au=Lindvall%2C+A&rft.au=Forsbeck%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mroz MM, Kreiss K, Lezotte DC, Campbell PA, Newman LS (July 1991). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.is\/20140815073419\/http:\/\/linkinghub.elsevier.com\/retrieve\/pii\/0091-6749(91)90300-D\" target=\"_blank\">\"Reexamination of the blood lymphocyte transformation test in the diagnosis of chronic beryllium disease\"<\/a>. <i>J Allergy Clin Immunol<\/i>. <b>88<\/b> (1): 54\u201360. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0091-6749%2891%2990300-D\" target=\"_blank\">10.1016\/0091-6749(91)90300-D<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2071785\" target=\"_blank\">2071785<\/a>. 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href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8933041\" target=\"_blank\">8933041<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Environ.+Health+Perspect.&rft.atitle=Significance+of+the+blood+beryllium+lymphocyte+proliferation+test&rft.volume=104&rft.issue=Suppl+5&rft.pages=953-6&rft.date=1996-10&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1469695&rft_id=info%3Apmid%2F8933041&rft_id=%2F%2Fwww.jstor.org%2Fstable%2F3433017&rft_id=info%3Adoi%2F10.2307%2F3433017&rft.au=Newman+LS&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1469695&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bach FH, Hirschhorn K (1964). \"Lymphocyte interaction: a potential histocompatibility test in vitro\". <i>Science<\/i>. <b>143<\/b> (3608): 813\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1126%2Fscience.143.3608.813\" target=\"_blank\">10.1126\/science.143.3608.813<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14088078\" 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id=\"cite_note-Stejskal2006-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Stejskal2006_21-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stejskal V, Hudecek R, Stejskal J, Sterzl I (2006). \"Diagnosis and treatment of metal-induced side-effects\". <i>Neuro Endocrinol Lett<\/i>. <b>27<\/b> (Suppl 1): 7\u201316. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17261999\" target=\"_blank\">17261999<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuro+Endocrinol+Lett.&rft.atitle=Diagnosis+and+treatment+of+metal-induced+side-effects&rft.volume=27&rft.issue=Suppl+1&rft.pages=7-16&rft.date=2006&rft_id=info%3Apmid%2F17261999&rft.aulast=Stejskal&rft.aufirst=V&rft.au=Hudecek%2C+R&rft.au=Stejskal%2C+J&rft.au=Sterzl%2C+I&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Valentine-Thon2006-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Valentine-Thon2006_22-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Valentine-Thon E, M\u00fcller K, Guzzi G, Kreisel S, Ohnsorge P, Sandkamp M (2006). \"LTT-MELISA\u00ae is clinically relevant for detecting and monitoring metal sensitivity\". <i>Neuro Endocrinol Lett<\/i>. <b>27<\/b> (Suppl 1): 17\u201324. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17261998\" target=\"_blank\">17261998<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neuro+Endocrinol+Lett.&rft.atitle=LTT-MELISA%C2%AE+is+clinically+relevant+for+detecting+and+monitoring+metal+sensitivity&rft.volume=27&rft.issue=Suppl+1&rft.pages=17-24&rft.date=2006&rft_id=info%3Apmid%2F17261998&rft.aulast=Valentine-Thon&rft.aufirst=E&rft.au=M%C3%BCller%2C+K&rft.au=Guzzi%2C+G&rft.au=Kreisel%2C+S&rft.au=Ohnsorge%2C+P&rft.au=Sandkamp%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMELISA\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1240\nCached time: 20181211213916\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.352 seconds\nReal time usage: 0.416 seconds\nPreprocessor visited node count: 1068\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 58098\/2097152 bytes\nTemplate argument size: 102\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 62117\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.232\/10.000 seconds\nLua memory usage: 4.02 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 358.503 1 -total\n<\/p>\n<pre>80.13% 287.253 1 Template:Reflist\n69.70% 249.874 21 Template:Cite_journal\n11.54% 41.370 1 Template:About\n 4.62% 16.577 1 Template:Immunologic_techniques_and_tests\n 4.30% 15.415 2 Template:Navbox\n 0.75% 2.678 1 Template:Main_other\n 0.62% 2.208 1 Template:Column-width\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:15818810-1!canonical and timestamp 20181211213916 and revision id 865390352\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/MELISA\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214713\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.166 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 158.384 1 - wikipedia:MELISA\n100.00% 158.384 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8578-0!*!*!*!*!*!* and timestamp 20181217214712 and revision id 25006\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/MELISA\">https:\/\/www.limswiki.org\/index.php\/MELISA<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","01459832dca0b3aa9299ecec4ba67886_images":[],"01459832dca0b3aa9299ecec4ba67886_timestamp":1545083232,"0e5a509a721423b5cae83265bbb80c85_type":"article","0e5a509a721423b5cae83265bbb80c85_title":"Medical test","0e5a509a721423b5cae83265bbb80c85_url":"https:\/\/www.limswiki.org\/index.php\/Medical_test","0e5a509a721423b5cae83265bbb80c85_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMedical test\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tMedical testX-ray of a hand. X-rays are a common medical test.MeSHD019937 [edit on Wikidata]\nA medical test is a medical procedure performed to detect, diagnose, or monitor diseases, disease processes, susceptibility, or to determine a course of treatment. Medical tests relate to clinical chemistry and molecular diagnostics, and are typically performed in a medical laboratory.\n\nContents \n\n1 Types of tests \n\n1.1 By purpose \n\n1.1.1 Diagnostic \n1.1.2 Screening \n1.1.3 Monitoring \n\n\n1.2 By method \n1.3 By sample location \n\n\n2 Accuracy and precision \n3 Detection and quantification \n\n3.1 Positive or negative \n3.2 Continuous values \n\n\n4 Interpretation \n5 Risks \n6 Indications \n7 Standard for the reporting and assessment \n8 See also \n9 Notes and references \n\n\nTypes of tests \nBy purpose \nMedical tests can be classified by their purposes, the most common of which are diagnosis, screening and evaluation.\n\nDiagnostic \n Lung scintigraphy evaluating lung cancer\nA diagnostic test is a procedure performed to confirm or determine the presence of disease in an individual suspected of having a disease, usually following the report of symptoms, or based on other medical test results.[1][2] This includes posthumous diagnosis. Examples of such tests are:\n\nUsing nuclear medicine to examine a patient suspected of having a lymphoma.\nMeasuring the blood sugar in a person suspected of having diabetes mellitus after periods of increased urination.\nTaking a complete blood count of an individual experiencing a high fever to check for a bacterial infection.[1]\nMonitoring electrocardiogram readings on a patient suffering chest pain to diagnose or determine any heart irregularities.[3]\nScreening \nMain article: Screening (medicine)\nScreening refers to a medical test or series of tests used to detect or predict the presence of disease in at risk individuals within a defined group such as a population, family, or workforce.[4][5] Screenings may be performed to monitor disease prevalence, manage epidemiology, aid in prevention, or strictly for statistical purposes.[6]\nExamples of screenings include measuring the level of TSH in the blood of a newborn infant as part of newborn screening for congenital hypothyroidism,[7] checking for Lung cancer in non-smoking individuals who are exposed to second-hand smoke in an unregulated working environment, and Pap smear screening for prevention or early detection of cervical cancer.\n\nMonitoring \nMain article: Monitoring (medicine)\nSome medical tests are used to monitor the progress of, or response to medical treatment.\n\nBy method \nMost test methods can be classified into one of the following broad groups:\n\nPatient observations, which may be photographed or recorded\nQuestions asked when taking an individual\u2019s medical history\nTests performed in a physical examination\nRadiologic tests, in which, for example, x-rays are used to form an image of a body target. These tests often involve administration of a contrast agent.\nIn vivo diagnostics which test in the body, such as:\nManometry[8]\nAdministering a diagnostic agent and measuring the body's response, as in the gluten challenge test, contraction stress test, bronchial challenge test, oral food challenge, or the ACTH stimulation test.\nIn vitro diagnostics which test a sample of tissue or bodily fluids,[9][10] such as:\nMicrobiological culturing, which determines the presence or absence of microbes in a sample from the body, and usually targeted at detecting pathogenic bacteria.\nGenetic testing\nBlood Glucose testing [11]\nLiver function testing [12]\nCalcium testing [12]\nTesting for electrolytes in the blood, such as Sodium, Potassium, Creatinine, and Urea [13]\nBy sample location \nIn vitro tests can be classified according to the location of the sample being tested, including:\n\nBlood tests\nUrine tests, including naked eye exam of the urine\nStool tests, including naked eye exam of the feces\nSputum (phlegm), including naked eye exam of the sputum\nAccuracy and precision \nMain article: Accuracy and precision\nAccuracy of a laboratory test is its correspondence with the true value. Accuracy is maximized by calibrating laboratory equipment with reference material and by participating in external quality control programs.\nPrecision of a test is its reproducibility when it is repeated on the same sample. An imprecise test yields widely varying results on repeated measurement. Precision is monitored in laboratory by using control material.\nDetection and quantification \nTests performed in a physical examination are usually aimed at detecting a symptom or sign, and in these cases, a test that detects a symptom or sign is designated a positive test, and a test that indicated absence of a symptom or sign is designated a negative test, as further detailed in separate section below.\nA quantification of a target substance, a cell type or another specific entity is a common output of, for example, most blood tests. This is not only answering if a target entity is present or absent, but also how much is present. In blood tests, the quantification is relatively well specified, such as given in mass concentration, while most other tests may be quantifications as well although less specified, such as a sign of being \"very pale\" rather than \"slightly pale\". Similarly, radiologic images are technically quantifications of radiologic opacity of tissues.\nEspecially in the taking of a medical history, there is no clear limit between a detecting or quantifying test versus rather descriptive information of an individual. For example, questions regarding the occupation or social life of an individual may be regarded as tests that can be regarded as positive or negative for the presence of various risk factors, or they may be regarded as \"merely\" descriptive, although the latter may be at least as clinically important.\n\nPositive or negative \nThe result of a test aimed at detection of an entity may be positive or negative: this has nothing to do with a bad prognosis, but rather means that the test worked or not, and a certain parameter that was evaluated was present or not. For example, a negative screening test for breast cancer means that no sign of breast cancer could be found (which is in fact very positive for the patient).\nThe classification of tests into either positive or negative gives a binary classification, with resultant ability to perform bayesian probability and performance metrics of tests, including calculations of sensitivity and specificity.\n\nContinuous values \nTests whose results are of continuous values, such as most blood values, can be interpreted as they are, or they can be converted to a binary ones by defining a cutoff value, with test results being designated as positive or negative depending on whether the resultant value is higher or lower than the cutoff.\n\nInterpretation \nFurther information: Pre- and post-test probability\nIn the finding of a pathognomonic sign or symptom it is almost certain that the target condition is present, and in the absence of finding a sine qua non sign or symptom it is almost certain that the target condition is absent. In reality, however, the subjective probability of the presence of a condition is never exactly 100% or 0%, so tests are rather aimed at estimating a post-test probability of a condition or other entity.\nMost diagnostic tests basically use a reference group to establish performance data such as predictive values, likelihood ratios and relative risks, which are then used to interpret the post-test probability for an individual.\nIn monitoring tests of an individual, the test results from previous tests on that individual may be used as a reference to interpret subsequent tests.\n\nRisks \nSome medical testing procedures have associated health risks, and even require general anesthesia, such as the mediastinoscopy.[14] Other tests, such as the blood test or pap smear have little to no direct risks.[15] Medical tests may also have indirect risks, such as the stress of testing, and riskier tests may be required as follow-up for a (potentially) false positive test result. Consult the health care provider (including physicians, physician assistants, and nurse practitioners) prescribing any test for further information.\n\nIndications \nEach test has its own indications and contraindications. An indication is a valid medical reason to perform the test. A contraindication is a valid medical reason to reject the test. For example, a basic cholesterol test may be indicated (medically appropriate) for a middle-aged person. However, if the same test was performed on that person very recently, then the existence of the previous test is a contraindication for the test (a medically valid reason to not perform it).\nInformation bias is the cognitive bias that causes healthcare providers to order tests that produce information that they do not realistically expect or intend to use for the purpose of making a medical decision. Medical tests are indicated when the information they produce will be used. For example, a screening mammogram is not indicated (not medically appropriate) for a woman who is dying, because even if breast cancer is found, she will die before any cancer treatment could begin.\nIn a simplified fashion, how much a test is indicated for an individual depends largely on its net benefit for that individual. Tests are chosen when the expected benefit is greater than the expected harm. The net benefit may roughly be estimated by:\n\n \n \n \n \n b\n \n n\n \n \n =\n Δ\n p\n ×\n \n r\n \n i\n \n \n ×\n (\n \n b\n \n i\n \n \n −\n \n h\n \n i\n \n \n )\n −\n \n h\n \n t\n \n \n \n \n {\\displaystyle b_{n}=\\Delta p\\times r_{i}\\times (b_{i}-h_{i})-h_{t}}\n \n\n \n\n<\/p>, where:\n\nbn is the net benefit of performing a test\n\u039bp is the absolute difference between pre- and posttest probability of conditions (such as diseases) that the test is expected to achieve. A major factor for such an absolute difference is the power of the test itself, such as can be described in terms of, for example, sensitivity and specificity or likelihood ratio. Another factor is the pre-test probability, with a lower pre-test probability resulting in a lower absolute difference, with the consequence that even very powerful tests achieve a low absolute difference for very unlikely conditions in an individual (such as rare diseases in the absenceower can make a great difference for highly suspected conditions. The probabilities in this sense may also need to be considered in context of conditions that are not primary targets of the test, such as profile-relative probabilities in a differential diagnostic procedure.\nri is the rate of how much probability differences are expected to result in changes in interventions (such as a change from \"no treatment\" to \"administration of low-dose medical treatment\"). For example, if the only expected effect of a medical test is to make one disease more likely compared to another, but the two diseases have the same treatment (or neither can be treated), then, this factor is very low and the test is probably without value for the individual in this aspect.\nbi is the benefit of changes in interventions for the individual\nhi is the harm of changes in interventions for the individual, such as side effects of medical treatment\nht is the harm caused by the test itself.\nSome additional factors that influence a decision whether a medical test should be performed or not included: cost of the test, availability of additional tests, potential interference with subsequent test (such as an abdominal palpation potentially inducing intestinal activity whose sounds interfere with a subsequent abdominal auscultation), time taken for the test or other practical or administrative aspects. The possible benefits of a diagnostic test may also be weighed against the costs of unnecessary tests and resulting unnecessary follow-up and possibly even unnecessary treatment of incidental findings.[16]\nIn some cases, tests being performed are expected to have no benefit for the individual being tested. Instead, the results may be useful for the establishment of statistics in order to improve health care for other individuals. Patients may give informed consent to undergo medical tests that will benefit other people.\n\nStandard for the reporting and assessment \nThe QUADAS-2 revision is available.[17]\n\nSee also \n\nBlood culture\nChemical test\nGold standard (test)\nMedical sign\nMolecular diagnostics\nNailbed assessment\nTest panel\nPoint-of-care testing\n\nNotes and references \n\n\n^ a b Al-Gwaiz LA, Babay HH (2007). \"The diagnostic value of absolute neutrophil count, band count and morphological changes of neutrophils in predicting bacterial infections\". Med Princ Pract. 16 (5): 344\u2013347. doi:10.1159\/000104806. PMID 17709921. \n\n^ Harvard.edu\r\nGuide to Diagnostic Tests from Harvard Health \n\n^ Harvard.edu \n\n^ Ratcliffe JM, Halperin WE, Frazier TM, Sundin DS, Delaney L, Hornung RW (1986). \"The prevalence of screening: a report from the National Institute of Occupational Safety and the Health National Occupational Hazard Survey\". Journal of Occupational Medicine. 28 (10): 906\u2013912. doi:10.1097\/00043764-198610000-00003. PMID 3021937. \n\n^ Osha.gov\r\n\nUS Dept. of Labor - Occupational Safety and Health Admin. \n\n^ Murthy LI, Halperin WE (1995). \"Medical Screening and Biological Monitoring: A guide to the literature for physicians\". Journal of Occupational and Environmental Medicine. 37 (2): 170\u2013184. doi:10.1097\/00043764-199502000-00016. PMID 7655958. \n\n^ Moltz KC, Postellon DC (1994). \"Congenital hypothyroidism and mental development\". Comprehensive Therapy. 20 (6): 342\u2013346. PMID 8062543. \n\n^ OSA | Design of a high-sensor count fibre optic manometry catheter for in-vivo colonic diagnostics \n\n^ Directive 98\/79\/CE on in vitro diagnostic medical devices \n\n^ [1] \n\n^ Glucose Tests: The Test \n\n^ a b Liver Function Tests: At a Glance \n\n^ Electrolytes: At a Glance \n\n^ Harvard.edu \n\n^ Diagnostic Tests > Pap Smear, Harvard University, archived from the original on June 8, 2007 \n\n^ Jarvik J, Hollingworth W, Martin B, Emerson S, Gray D, Overman S, Robinson D, Staiger T, Wessbecher F, Sullivan S, Kreuter W, Deyo R (2003). \"Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial\". JAMA. 289 (21): 2810\u20138. doi:10.1001\/jama.289.21.2810. PMID 12783911. \n\n^ Whiting, Penny F.; Anne W.S. Rutjes; Marie E. Westwood; Susan Mallett; Jonathan J. Deeks; Johannes B. Reitsma; Mariska M.G. Leeflang; Jonathan A.C. Sterne; Patrick M.M. Bossuyt; QUADAS-2 Group (2011-10-18). \"QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies\". Annals of Internal Medicine. 155 (8): 529\u2013536. doi:10.7326\/0003-4819-155-8-201110180-00009. Archived from the original on 2012-02-11. Retrieved 2011-10-18 . \n\n\nvteMedical imaging (ICD-9-CM V3 87\u201388, ICD-10-PCS B, CPT 70010\u201379999)X-ray\/\r\nRadiography2DMedical:\nPneumoencephalography\nDental radiography\nSialography\nMyelography\nCXR\nBronchography\nAXR\nKUB\nDXA\/DXR\nUpper gastrointestinal series\/Small-bowel follow-through\/Lower gastrointestinal series\nCholangiography\/Cholecystography\nMammography\nPyelogram\nCystography\nArthrogram\nHysterosalpingography\nSkeletal survey\nAngiography\nAngiocardiography\nAortography\nVenography\nLymphogram\nIndustrial:\nRadiographic testing\nCT scanTechniques:\nGeneral operation of CT\nQuantitative CT\nHigh resolution CT\nX-ray microtomography\nElectron beam tomography\nTargets\nCoronary\nCalcium scan\nCT angiography\nAbdominal and pelvic CT\nVirtual colonoscopy\nCT angiography\nCoronary CT\nPulmonary CT\nHead CT\nThyroid CT\nWhole body imaging\nFull-body CT scan\nOther\nFluoroscopy\nDental panoramic radiography\nX-ray motion analysis\nMRI\nMRI of the brain\nMR neurography\nCardiac MRI\/Cardiac MRI perfusion\nMR angiography\nMR cholangiopancreatography\nBreast MRI\nFunctional MRI\nSequences\nDiffusion MRI\nPerfusion MRI\nTractography\nSynthetic MRI\nUltrasound\nEchocardiography\nDoppler ultrasonography\nDoppler echocardiography\nTTE\nTEE\nTranscranial Doppler\nIntravascular\nGynecologic\nObstetric\nEchoencephalography\nAbdominal ultrasonography\nTransrectal\nBreast ultrasound\nTransscrotal ultrasound\nCarotid ultrasonography\nContrast-enhanced\n3D ultrasound\nEndoscopic ultrasound\nEmergency ultrasound\nFAST\nPre-hospital ultrasound\nDuplex\nRadionuclide2D \/ scintigraphy\nCholescintigraphy\nScintimammography\nVentilation\/perfusion scan\nRadionuclide ventriculography\nRadionuclide angiography\nRadioisotope renography\nSestamibi parathyroid scintigraphy\nRadioactive iodine uptake test\nBone scintigraphy\nImmunoscintigraphy\nDacryoscintigraphy\nDMSA scan\nGastric emptying scan\nFull body:\nOctreotide scan\nGallium 67 scan\nIndium-111 WBC scan\n3D \/ ECTSPECT (gamma ray):\nMyocardial perfusion imaging\nPET (positron):\nBrain PET\nCardiac PET\nPET mammography\nPET-CT\nPET-MRI\nOptical\/Laser\nOptical tomography\nOptical coherence tomography\nConfocal microscopy\nEndomicroscopy\nOrthogonal polarization spectral imaging\nThermography\nnon-contact thermography\ncontact thermography\ndynamic angiothermography\n\nvteComponents and results of urine tests (CPT 81000\u201381099; R80\u2013R82, 791)Components\nAlbumin\nMyoglobin\nhCG\nLeukocyte esterase\nUrine pregnancy test\nKetone bodies\nGlucose\nUrobilinogen\nBilirubin\nCreatinine\nRBC\nWBC\nUrinary casts\nChemical properties\nUrine specific gravity\nUrine osmolality\nUrine pH\nUrine anion gap\nAbnormal findingsRed blood cells\nHematuria (Microscopic hematuria)\nWhite blood cells\nEosinophiluria\nProteinuria\nAlbuminuria\/Microalbuminuria\nMyoglobinuria\nHemoglobinuria\nSmall molecules\nGlycosuria\nKetonuria\nBilirubinuria\nHyperuricosuria\/Hypouricosuria\nAminoaciduria\nPathogens\nBacteriuria\nOther\nChyluria\nCrystalluria\nosmolality (Isosthenuria, Hypersthenuria)\n\nvteCommon for blood tests (CPT 82000\u201384999)Electrolytes\nSodium\nPotassium\nChloride\nCalcium\nRenal function\nCreatinine\nUrea\nBUN-to-creatinine ratio\nPlasma osmolality\nSerum osmolal gap\nAcid-base\nAnion gap\nArterial blood gas\nBase excess\nBicarbonate\nCO2 content\nIron tests\nFerritin\nSerum iron\nTransferrin saturation\nTotal iron-binding capacity\nTransferrin\nTransferrin receptor\nHormones\nACTH stimulation test\nThyroid function tests\nThyroid-stimulating hormone\nMetabolism\nBlood lipids\nCardiovascular\nCardiac marker\nTroponin test\nCPK-MB test\nLactate dehydrogenase\nMyoglobin\nGlycogen phosphorylase isoenzyme BB\nLiver function tests\nProteins\nHuman serum albumin\nSerum total protein\nALP\ntransaminases\nALT\nAST\nAST\/ALT ratio\nBilirubin\nUnconjugated\nConjugated\nPancreas\nAmylase\nLipase\nPancreatic lipase\n\nvteMyeloid blood tests (CPT 85002\u201385999)Clotting\nCBC\nPlatelet count\nMean platelet volume\nvWF:\nRistocetin-induced platelet aggregation\nclotting factors: \nProthrombin time\nPartial thromboplastin time\nThrombin time\nActivated clotting time\nother\/general: \ncoagulation\nBleeding time\nanimal enzyme\nReptilase time\nEcarin clotting time\nDilute Russell's viper venom time\nThromboelastography\nThrombodynamics test\nfibrinolysis: \nEuglobulin lysis time\nD-dimer\nRed blood cell indicesCBC \nRBC count\nHematocrit\nHemoglobin\nratios: \nMean corpuscular hemoglobin\nMean corpuscular hemoglobin concentration\nMean corpuscular volume\nRed blood cell distribution width\nFetal hemoglobin:\nApt\u2013Downey test\nKleihauer\u2013Betke test\nOther \nReticulocyte index\nHaptoglobin\nMentzer index\nCFU-GM\nNitro blue tetrazolium chloride test\nComplete blood count\nAbsolute neutrophil count\nOther\nBlood film\nLeucoerythroblastic\nBlood viscosity\nErythrocyte sedimentation rate\n\nvteMedical tests on Cerebrospinal fluid (CPT 82000-84999)Albumin\nCSF albumin\nCSF\/serum albumin ratio\nGlucose\nCSF glucose\nCSF\/serum glucose ratio\nOther\nBaricity\n\nvteMedical tests used in immunology and for inflammation (CPT 86000\u201386849)ImmunologyImmunoprecipitation\nChromatin immunoprecipitation\nImmunodiffusion\nOuchterlony double immunodiffusion\nRadial immunodiffusion\nImmunoelectrophoresis\nCounterimmunoelectrophoresis\nImmunoassay\nELISA\nELISPOT\nEnzyme Multiplied Immunoassay Technique\nRAST test\nRadioimmunoassay\nRadiobinding assay\nImmunofluorescence\nAgglutination\nHemagglutination\/Hemagglutinin\nCoombs test\nLatex fixation test\nOther\nDiagnostic immunology\nNephelometry\nComplement fixation test\nImmunocytochemistry\nImmunohistochemistry\nDirect fluorescent antibody\nEpitope mapping\nSkin allergy test\nPatch test\nInflammation\nC-reactive protein\nProcalcitonin\nTotal complement activity\nMELISA\nComplete blood count\nlymphocyte count\n\nvteAutoantibodiesAnti-nuclear antibody\nPBC:\nAnti-gp210\nAnti-p62\nAnti-sp100\nENA:\nAnti-topoisomerase\/Scl-70\nAnti-Jo1\nENA4\nAnti-Sm\nAnti-nRNP\nAnti-Ro\nAnti-La\nAnti-centromere\nAnti-dsDNA\nAnti-mitochondrial antibody\nAnti-cardiolipin\nAnti-cytoplasm antibody\nAnti-neutrophil cytoplasmic\nC-ANCA\nP-ANCA\nAnti-smooth muscle\nAnti-actin\nAnti-TPO\/Antimicrosomal\nCell membrane\nAnti-ganglioside\nAnti-GBM\nAnti-glutamate\nExtracellular\nAnti-thrombin\nLupus anticoagulant\nCoeliac disease:\nAnti-transglutaminase\nAnti-gliadin not autoantibody\nRA\nRheumatoid factor\/anti-IgG\nAnti-citrullinated peptide\nMultiple locations\nAnti-phospholipid\nAnti-apolipoprotein\n\nvteTransfusion medicineGeneral concepts\nApheresis (plasmapheresis, plateletpheresis, leukapheresis)\nBlood transfusion\nCoombs test (direct and indirect)\nCross-matching\nExchange transfusion\nInternational Society of Blood Transfusion\nIntraoperative blood salvage\nISBT 128\nTransfusion reactions\nBlood group systems \/\r\nblood types\nABO\nChido-Rodgers\nColton\nCromer\nDiego\nDombrock\nDuffy\nEr\nFORS\nGerbich\nGIL\nGLOB\nHh\nIi\nIndian\nJR\nJMH\nKell (Xk)\nKidd\nKnops\nLan\nLewis\nLutheran\nLW\nMNS\nOK\nP\nRaph\nRh and RHAG\nScianna\nT-Tn\nVel\nXg\nYt\nOther\nBlood products \/\r\nblood donation\nWhole blood\nPlatelets\nRed blood cells\nPlasma \/ Fresh frozen plasma \/ PF24 (Cryoprecipitate + Cryosupernatant)\nBlood substitutes\n\nvteMedical test: Infectious disease blood tests (CPT 87001\u201387999)Bacterial infection\nsyphilis\nVDRL\nrapid plasma reagin\nWassermann test\nFTA-ABS\nRickettsia\nWeil\u2013Felix test\nHelicobacter\nHelicoCARE direct\nStreptococcus\nantistreptolysin O titre\nViral infection\nHIV\nHIV test\nBDNA test\nmChip\nEpstein\u2013Barr virus\nmonospot test\nDengue fever\nNS1 antigen test\nProtozoan infection\ntoxoplasmosis\nSabin\u2013Feldman dye test\n\nvtePathologyPrinciples of pathology\nDisease\nInfection\nNeoplasia\nCause\nPathogenesis\nHemodynamics\nIschemia\nInflammation\nCell damage\nWound healing\nCellular adaptation\n\nAtrophy\nHypertrophy\nHyperplasia\nDysplasia\nMetaplasia\nSquamous\nGlandular<\/dd>\nCell death\n\nNecrosis\nCoagulative necrosis\nLiquefactive necrosis\nGangrenous necrosis\nCaseous necrosis\nFat necrosis\nFibrinoid necrosis<\/dd>\nProgrammed cell death\n\nApoptosis<\/dd>\nPyknosis\nKaryorrhexis\n\nKaryolysis\nAccumulations\npigment\nHemosiderin\nLipochrome\/Lipofuscin\nMelanin<\/dd>\nSteatosis\nAnatomical pathology\nSurgical pathology\nCytopathology\nAutopsy\nMolecular pathology\nForensic pathology\nOral and maxillofacial pathology\nGross examination\nHistopathology\nImmunohistochemistry\nElectron microscopy\nImmunofluorescence\nFluorescence in situ hybridization\nClinical pathology\nClinical chemistry\nHematopathology\nTransfusion medicine\nMedical microbiology\nDiagnostic immunology\nImmunopathology\nEnzyme assay\nMass spectrometry\nChromatography\nFlow cytometry\nBlood bank\nMicrobiological culture\nSerology\n\nvteMedical test: ElectrodiagnosisHeart\nElectrocardiography\nVectorcardiography\nMagnetocardiography\nCentral nervous system\nElectroencephalography (Intracranial EEG, stereoelectroencephalography)\nMagnetoencephalography\nPeripheral nervous system\nElectromyography (Facial electromyography)\nNerve conduction study\nEars\nElectrocochleography\nEyes\nElectronystagmography\nElectrooculography\nElectroretinography\nDigestive system\nElectrogastrogram\nMagnetogastrography\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_test\">https:\/\/www.limswiki.org\/index.php\/Medical_test<\/a>\n\t\t\t\t\tCategory: Healthcare termsHidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","0e5a509a721423b5cae83265bbb80c85_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Medical_test skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Medical test<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>A <b>medical test<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_procedure\" title=\"Medical procedure\" rel=\"external_link\" target=\"_blank\">medical procedure<\/a> performed to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screening_(medicine)\" title=\"Screening (medicine)\" rel=\"external_link\" target=\"_blank\">detect<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_diagnosis\" title=\"Medical diagnosis\" rel=\"external_link\" target=\"_blank\">diagnose<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monitoring_(medicine)\" title=\"Monitoring (medicine)\" rel=\"external_link\" target=\"_blank\">monitor<\/a> diseases, disease processes, susceptibility, or to determine a course of treatment. Medical tests relate to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_chemistry\" title=\"Clinical chemistry\" rel=\"external_link\" target=\"_blank\">clinical chemistry<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_diagnostics\" title=\"Molecular diagnostics\" rel=\"external_link\" target=\"_blank\">molecular diagnostics<\/a>, and are typically performed in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_laboratory\" title=\"Medical laboratory\" rel=\"external_link\" target=\"_blank\">medical laboratory<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types_of_tests\">Types of tests<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"By_purpose\">By purpose<\/span><\/h3>\n<p>Medical tests can be classified by their purposes, the most common of which are diagnosis, screening and evaluation.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Diagnostic\">Diagnostic<\/span><\/h4>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Lung_scintigraphy_keosys.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/85\/Lung_scintigraphy_keosys.JPG\/220px-Lung_scintigraphy_keosys.JPG\" width=\"220\" height=\"138\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Lung_scintigraphy_keosys.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Lung <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scintigraphy\" title=\"Scintigraphy\" rel=\"external_link\" target=\"_blank\">scintigraphy<\/a> evaluating lung cancer<\/div><\/div><\/div>\n<p>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diagnostic_test\" class=\"mw-redirect\" title=\"Diagnostic test\" rel=\"external_link\" target=\"_blank\">diagnostic test<\/a> is a procedure performed to confirm or determine the presence of disease in an individual suspected of having a disease, usually following the report of symptoms, or based on other medical test results.<sup id=\"rdp-ebb-cite_ref-anc_1-0\" class=\"reference\"><a href=\"#cite_note-anc-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> This includes <a href=\"https:\/\/en.wikipedia.org\/wiki\/Posthumous_diagnosis\" class=\"mw-redirect\" title=\"Posthumous diagnosis\" rel=\"external_link\" target=\"_blank\">posthumous diagnosis<\/a>. Examples of such tests are:\n<\/p>\n<ul><li>Using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_medicine\" title=\"Nuclear medicine\" rel=\"external_link\" target=\"_blank\">nuclear medicine<\/a> to examine a patient suspected of having a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lymphoma\" title=\"Lymphoma\" rel=\"external_link\" target=\"_blank\">lymphoma<\/a>.<\/li>\n<li>Measuring the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_sugar\" class=\"mw-redirect\" title=\"Blood sugar\" rel=\"external_link\" target=\"_blank\">blood sugar<\/a> in a person suspected of having <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetes_mellitus\" title=\"Diabetes mellitus\" rel=\"external_link\" target=\"_blank\">diabetes mellitus<\/a> after periods of increased <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urination\" title=\"Urination\" rel=\"external_link\" target=\"_blank\">urination<\/a>.<\/li>\n<li>Taking a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Complete_blood_count\" title=\"Complete blood count\" rel=\"external_link\" target=\"_blank\">complete blood count<\/a> of an individual experiencing a high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fever\" title=\"Fever\" rel=\"external_link\" target=\"_blank\">fever<\/a> to check for a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bacterial_infection\" class=\"mw-redirect\" title=\"Bacterial infection\" rel=\"external_link\" target=\"_blank\">bacterial infection<\/a>.<sup id=\"rdp-ebb-cite_ref-anc_1-1\" class=\"reference\"><a href=\"#cite_note-anc-1\" rel=\"external_link\">[1]<\/a><\/sup><\/li>\n<li>Monitoring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrocardiogram\" class=\"mw-redirect\" title=\"Electrocardiogram\" rel=\"external_link\" target=\"_blank\">electrocardiogram<\/a> readings on a patient suffering <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest_pain\" title=\"Chest pain\" rel=\"external_link\" target=\"_blank\">chest pain<\/a> to diagnose or determine any <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart\" title=\"Heart\" rel=\"external_link\" target=\"_blank\">heart<\/a> irregularities.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li><\/ul>\n<h4><span class=\"mw-headline\" id=\"Screening\">Screening<\/span><\/h4>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screening_(medicine)\" title=\"Screening (medicine)\" rel=\"external_link\" target=\"_blank\">Screening (medicine)<\/a><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Screening_(medicine)\" title=\"Screening (medicine)\" rel=\"external_link\" target=\"_blank\">Screening<\/a> refers to a medical test or series of tests used to detect or predict the presence of disease in at risk individuals within a defined group such as a population, family, or workforce.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Screenings may be performed to monitor disease prevalence, manage epidemiology, aid in prevention, or strictly for statistical purposes.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>Examples of screenings include measuring the level of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thyroid-stimulating_hormone\" title=\"Thyroid-stimulating hormone\" rel=\"external_link\" target=\"_blank\">TSH<\/a> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood\" title=\"Blood\" rel=\"external_link\" target=\"_blank\">blood<\/a> of a newborn <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infant\" title=\"Infant\" rel=\"external_link\" target=\"_blank\">infant<\/a> as part of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Newborn_screening\" title=\"Newborn screening\" rel=\"external_link\" target=\"_blank\">newborn screening<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital_hypothyroidism\" title=\"Congenital hypothyroidism\" rel=\"external_link\" target=\"_blank\">congenital hypothyroidism<\/a>,<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> checking for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lung_cancer\" title=\"Lung cancer\" rel=\"external_link\" target=\"_blank\">Lung cancer<\/a> in non-smoking individuals who are exposed to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Passive_smoke\" class=\"mw-redirect\" title=\"Passive smoke\" rel=\"external_link\" target=\"_blank\">second-hand smoke<\/a> in an unregulated working environment, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pap_test\" title=\"Pap test\" rel=\"external_link\" target=\"_blank\">Pap smear<\/a> screening for prevention or early detection of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervical_cancer\" title=\"Cervical cancer\" rel=\"external_link\" target=\"_blank\">cervical cancer<\/a>.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Monitoring\">Monitoring<\/span><\/h4>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monitoring_(medicine)\" title=\"Monitoring (medicine)\" rel=\"external_link\" target=\"_blank\">Monitoring (medicine)<\/a><\/div>\n<p>Some medical tests are used to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monitoring_(medicine)\" title=\"Monitoring (medicine)\" rel=\"external_link\" target=\"_blank\">monitor<\/a> the progress of, or response to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Therapy\" title=\"Therapy\" rel=\"external_link\" target=\"_blank\">medical treatment<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"By_method\">By method<\/span><\/h3>\n<p>Most test methods can be classified into one of the following broad groups:\n<\/p>\n<ul><li>Patient observations, which may be photographed or recorded<\/li>\n<li>Questions asked when taking an individual\u2019s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_history\" title=\"Medical history\" rel=\"external_link\" target=\"_blank\">medical history<\/a><\/li>\n<li>Tests performed in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_examination\" title=\"Physical examination\" rel=\"external_link\" target=\"_blank\">physical examination<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiologic\" class=\"mw-redirect\" title=\"Radiologic\" rel=\"external_link\" target=\"_blank\">Radiologic<\/a> tests, in which, for example, <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-rays\" class=\"mw-redirect\" title=\"X-rays\" rel=\"external_link\" target=\"_blank\">x-rays<\/a> are used to form an image of a body target. These tests often involve administration of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Contrast_medium\" class=\"mw-redirect\" title=\"Contrast medium\" rel=\"external_link\" target=\"_blank\">contrast agent<\/a>.<\/li>\n<li><b>In vivo diagnostics<\/b> which test in the body, such as:\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Manometry\" title=\"Manometry\" rel=\"external_link\" target=\"_blank\">Manometry<\/a><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><\/li>\n<li>Administering a diagnostic agent and measuring the body's response, as in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluten_challenge_test\" title=\"Gluten challenge test\" rel=\"external_link\" target=\"_blank\">gluten challenge test<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Contraction_stress_test\" title=\"Contraction stress test\" rel=\"external_link\" target=\"_blank\">contraction stress test<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bronchial_challenge_test\" title=\"Bronchial challenge test\" rel=\"external_link\" target=\"_blank\">bronchial challenge test<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oral_food_challenge\" title=\"Oral food challenge\" rel=\"external_link\" target=\"_blank\">oral food challenge<\/a>, or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ACTH_stimulation_test\" title=\"ACTH stimulation test\" rel=\"external_link\" target=\"_blank\">ACTH stimulation test<\/a>.<\/li><\/ul><\/li>\n<li><b><span id=\"rdp-ebb-In_vitro_diagnostics\">In vitro diagnostics<\/span><\/b> which test a sample of tissue or bodily fluids,<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> such as:\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Microbiological_culture\" title=\"Microbiological culture\" rel=\"external_link\" target=\"_blank\">Microbiological culturing<\/a>, which determines the presence or absence of microbes in a sample from the body, and usually targeted at detecting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pathogenic_bacteria\" title=\"Pathogenic bacteria\" rel=\"external_link\" target=\"_blank\">pathogenic bacteria<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Genetic_testing\" title=\"Genetic testing\" rel=\"external_link\" target=\"_blank\">Genetic testing<\/a><\/li>\n<li>Blood <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose\" title=\"Glucose\" rel=\"external_link\" target=\"_blank\">Glucose<\/a> testing <sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><\/li>\n<li>Liver function testing <sup id=\"rdp-ebb-cite_ref-labtestsonline.org.uk_12-0\" class=\"reference\"><a href=\"#cite_note-labtestsonline.org.uk-12\" rel=\"external_link\">[12]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium\" title=\"Calcium\" rel=\"external_link\" target=\"_blank\">Calcium<\/a> testing <sup id=\"rdp-ebb-cite_ref-labtestsonline.org.uk_12-1\" class=\"reference\"><a href=\"#cite_note-labtestsonline.org.uk-12\" rel=\"external_link\">[12]<\/a><\/sup><\/li>\n<li>Testing for electrolytes in the blood, such as Sodium, Potassium, Creatinine, and Urea <sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><\/li><\/ul><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"By_sample_location\">By sample location<\/span><\/h3>\n<p>In vitro tests can be classified according to the location of the sample being tested, including:\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_test\" title=\"Blood test\" rel=\"external_link\" target=\"_blank\">Blood tests<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinalysis\" class=\"mw-redirect\" title=\"Urinalysis\" rel=\"external_link\" target=\"_blank\">Urine tests<\/a>, including naked eye exam of the urine<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Stool_test\" title=\"Stool test\" rel=\"external_link\" target=\"_blank\">Stool tests<\/a>, including naked eye exam of the feces<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sputum\" title=\"Sputum\" rel=\"external_link\" target=\"_blank\">Sputum<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Phlegm\" title=\"Phlegm\" rel=\"external_link\" target=\"_blank\">phlegm<\/a>), including naked eye exam of the sputum<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Accuracy_and_precision\">Accuracy and precision<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Accuracy_and_precision\" title=\"Accuracy and precision\" rel=\"external_link\" target=\"_blank\">Accuracy and precision<\/a><\/div>\n<ul><li><b>Accuracy<\/b> of a laboratory test is its correspondence with the true value. Accuracy is maximized by calibrating laboratory equipment with reference material and by participating in external quality control programs.<\/li>\n<li><b>Precision<\/b> of a test is its reproducibility when it is repeated on the same sample. An imprecise test yields widely varying results on repeated measurement. Precision is monitored in laboratory by using control material.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Detection_and_quantification\">Detection and quantification<\/span><\/h2>\n<p>Tests performed in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_examination\" title=\"Physical examination\" rel=\"external_link\" target=\"_blank\">physical examination<\/a> are usually aimed at detecting a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Symptom\" title=\"Symptom\" rel=\"external_link\" target=\"_blank\">symptom<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_sign\" title=\"Medical sign\" rel=\"external_link\" target=\"_blank\">sign<\/a>, and in these cases, a test that detects a symptom or sign is designated a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Positive_test\" class=\"mw-redirect\" title=\"Positive test\" rel=\"external_link\" target=\"_blank\">positive test<\/a>, and a test that indicated absence of a symptom or sign is designated a , as further detailed in separate section below.\n<\/p><p>A quantification of a target substance, a cell type or another specific entity is a common output of, for example, most <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_test\" title=\"Blood test\" rel=\"external_link\" target=\"_blank\">blood tests<\/a>. This is not only answering <i>if<\/i> a target entity is present or absent, but also <i>how much<\/i> is present. In blood tests, the quantification is relatively well specified, such as given in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mass_concentration_(chemistry)\" title=\"Mass concentration (chemistry)\" rel=\"external_link\" target=\"_blank\">mass concentration<\/a>, while most other tests may be quantifications as well although less specified, such as a sign of being \"very <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pallor\" title=\"Pallor\" rel=\"external_link\" target=\"_blank\">pale<\/a>\" rather than \"slightly pale\". Similarly, radiologic images are technically quantifications of radiologic opacity of tissues.\n<\/p><p>Especially in the taking of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_history\" title=\"Medical history\" rel=\"external_link\" target=\"_blank\">medical history<\/a>, there is no clear limit between a detecting or quantifying test versus rather <i>descriptive<\/i> information of an individual. For example, questions regarding the occupation or social life of an individual may be regarded as tests that can be regarded as positive or negative for the presence of various risk factors, or they may be regarded as \"merely\" descriptive, although the latter may be at least as clinically important.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Positive_or_negative\">Positive or negative<\/span><\/h3>\n<p>The result of a test aimed at detection of an entity may be <b>positive<\/b> or <b>negative<\/b>: this has nothing to do with a bad <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prognosis\" title=\"Prognosis\" rel=\"external_link\" target=\"_blank\">prognosis<\/a>, but rather means that the test worked or not, and a certain parameter that was evaluated was present or not. For example, a negative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screening_test\" class=\"mw-redirect\" title=\"Screening test\" rel=\"external_link\" target=\"_blank\">screening test<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Breast_cancer\" title=\"Breast cancer\" rel=\"external_link\" target=\"_blank\">breast cancer<\/a> means that no sign of breast cancer could be found (which is in fact very positive for the patient).\n<\/p><p>The classification of tests into either positive or negative gives a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Binary_classification\" title=\"Binary classification\" rel=\"external_link\" target=\"_blank\">binary classification<\/a>, with resultant ability to perform <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bayesian_probability\" title=\"Bayesian probability\" rel=\"external_link\" target=\"_blank\">bayesian probability<\/a> and performance metrics of tests, including calculations of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sensitivity_and_specificity\" title=\"Sensitivity and specificity\" rel=\"external_link\" target=\"_blank\">sensitivity and specificity<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Continuous_values\">Continuous values<\/span><\/h3>\n<p>Tests whose results are of continuous values, such as most <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_values\" class=\"mw-redirect\" title=\"Blood values\" rel=\"external_link\" target=\"_blank\">blood values<\/a>, can be interpreted as they are, or they can be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificially_binary_value\" class=\"mw-redirect\" title=\"Artificially binary value\" rel=\"external_link\" target=\"_blank\">converted to a binary ones<\/a> by defining a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cutoff_(reference_value)\" class=\"mw-redirect\" title=\"Cutoff (reference value)\" rel=\"external_link\" target=\"_blank\">cutoff value<\/a>, with test results being designated as positive or negative depending on whether the resultant value is higher or lower than the cutoff.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Interpretation\">Interpretation<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pre-_and_post-test_probability\" title=\"Pre- and post-test probability\" rel=\"external_link\" target=\"_blank\">Pre- and post-test probability<\/a><\/div>\n<p>In the finding of a <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pathognomonic\" title=\"Pathognomonic\" rel=\"external_link\" target=\"_blank\">pathognomonic<\/a><\/i> sign or symptom it is almost certain that the target condition is present, and in the absence of finding a <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sine_qua_non\" title=\"Sine qua non\" rel=\"external_link\" target=\"_blank\">sine qua non<\/a><\/i> sign or symptom it is almost certain that the target condition is absent. In reality, however, the subjective probability of the presence of a condition is never exactly 100% or 0%, so tests are rather aimed at estimating a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Post-test_probability\" class=\"mw-redirect\" title=\"Post-test probability\" rel=\"external_link\" target=\"_blank\">post-test probability<\/a> of a condition or other entity.\n<\/p><p>Most diagnostic tests basically use a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reference_group\" title=\"Reference group\" rel=\"external_link\" target=\"_blank\">reference group<\/a> to establish performance data such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Predictive_values\" class=\"mw-redirect\" title=\"Predictive values\" rel=\"external_link\" target=\"_blank\">predictive values<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Likelihood_ratios_in_diagnostic_testing\" title=\"Likelihood ratios in diagnostic testing\" rel=\"external_link\" target=\"_blank\">likelihood ratios<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Relative_risk\" class=\"mw-redirect\" title=\"Relative risk\" rel=\"external_link\" target=\"_blank\">relative risks<\/a>, which are then used to interpret the post-test probability for an individual.\n<\/p><p>In monitoring tests of an individual, the test results from previous tests on that individual may be used as a reference to interpret subsequent tests.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<p>Some medical testing procedures have associated health risks, and even require <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_anesthesia\" class=\"mw-redirect\" title=\"General anesthesia\" rel=\"external_link\" target=\"_blank\">general anesthesia<\/a>, such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mediastinoscopy\" title=\"Mediastinoscopy\" rel=\"external_link\" target=\"_blank\">mediastinoscopy<\/a>.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> Other tests, such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_test\" title=\"Blood test\" rel=\"external_link\" target=\"_blank\">blood test<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pap_smear\" class=\"mw-redirect\" title=\"Pap smear\" rel=\"external_link\" target=\"_blank\">pap smear<\/a> have little to no direct risks.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> Medical tests may also have <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screening_(medicine)#Adverse_effects_of_screening\" title=\"Screening (medicine)\" rel=\"external_link\" target=\"_blank\">indirect risks<\/a>, such as the stress of testing, and riskier tests may be required as follow-up for a (potentially) <a href=\"https:\/\/en.wikipedia.org\/wiki\/False_positive\" class=\"mw-redirect\" title=\"False positive\" rel=\"external_link\" target=\"_blank\">false positive<\/a> test result. Consult the health care provider (including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physician\" title=\"Physician\" rel=\"external_link\" target=\"_blank\">physicians<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physician_assistant\" title=\"Physician assistant\" rel=\"external_link\" target=\"_blank\">physician assistants<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nurse_practitioner\" title=\"Nurse practitioner\" rel=\"external_link\" target=\"_blank\">nurse practitioners<\/a>) prescribing any test for further information.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<p>Each test has its own <a href=\"https:\/\/en.wikipedia.org\/wiki\/Indication_(medicine)\" title=\"Indication (medicine)\" rel=\"external_link\" target=\"_blank\">indications<\/a> and contraindications. An <i>indication<\/i> is a valid medical reason to perform the test. A <i>contraindication<\/i> is a valid medical reason to reject the test. For example, a basic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholesterol_test\" class=\"mw-redirect\" title=\"Cholesterol test\" rel=\"external_link\" target=\"_blank\">cholesterol test<\/a> may be <i>indicated<\/i> (medically appropriate) for a middle-aged person. However, if the same test was performed on that person very recently, then the existence of the previous test is a contraindication for the test (a medically valid reason to not perform it).\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Information_bias_(psychology)\" title=\"Information bias (psychology)\" rel=\"external_link\" target=\"_blank\">Information bias<\/a> is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cognitive_bias\" title=\"Cognitive bias\" rel=\"external_link\" target=\"_blank\">cognitive bias<\/a> that causes healthcare providers to order tests that produce information that they do not realistically expect or intend to use for the purpose of making a medical decision. Medical tests are indicated when the information they produce will be used. For example, a screening mammogram is not indicated (not medically appropriate) for a woman who is dying, because even if breast cancer is found, she will die before any cancer treatment could begin.\n<\/p><p>In a simplified fashion, how much a test is indicated for an individual depends largely on its <i>net benefit<\/i> for that individual. Tests are chosen when the expected benefit is greater than the expected harm. The net benefit may roughly be estimated by:\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/64175fee57b3280abca7eb3105859bfc169bcdc3\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.838ex; width:29.54ex; height:2.843ex;\" alt=\"b_{n}=\\Delta p\\times r_{i}\\times (b_{i}-h_{i})-h_{t}\"\/><\/span>\n<\/p>\n<\/p><p>, where:\n<\/p>\n<ul><li><i>b<sub>n<\/sub><\/i> is the net benefit of performing a test<\/li>\n<li><i>\u039bp<\/i> is the absolute difference between <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pre-_and_posttest_probability\" class=\"mw-redirect\" title=\"Pre- and posttest probability\" rel=\"external_link\" target=\"_blank\">pre- and posttest probability<\/a> of conditions (such as diseases) that the test is expected to achieve. A major factor for such an absolute difference is the power of the test itself, such as can be described in terms of, for example, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sensitivity_and_specificity\" title=\"Sensitivity and specificity\" rel=\"external_link\" target=\"_blank\">sensitivity and specificity<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Likelihood_ratios_in_diagnostic_testing\" title=\"Likelihood ratios in diagnostic testing\" rel=\"external_link\" target=\"_blank\">likelihood ratio<\/a>. Another factor is the pre-test probability, with a lower pre-test probability resulting in a lower absolute difference, with the consequence that even very powerful tests achieve a low absolute difference for very unlikely conditions in an individual (such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rare_disease\" title=\"Rare disease\" rel=\"external_link\" target=\"_blank\">rare diseases<\/a> in the absenceower can make a great difference for highly suspected conditions. The probabilities in this sense may also need to be considered in context of conditions that are not primary targets of the test, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Differential_diagnosis#profile-relative_probability\" title=\"Differential diagnosis\" rel=\"external_link\" target=\"_blank\">profile-relative probabilities in a differential diagnostic procedure<\/a>.<\/li>\n<li><i>r<sub>i<\/sub><\/i> is the rate of how much <i>probability differences<\/i> are expected to result in <i>changes in interventions<\/i> (such as a change from \"no treatment\" to \"administration of low-dose medical treatment\"). For example, if the only expected effect of a medical test is to make one disease more likely compared to another, but the two diseases have the same treatment (or neither can be treated), then, this factor is very low and the test is probably without value for the individual in this aspect.<\/li>\n<li><i>b<sub>i<\/sub><\/i> is the benefit of <i>changes in interventions<\/i> for the individual<\/li>\n<li><i>h<sub>i<\/sub><\/i> is the harm of <i>changes in interventions<\/i> for the individual, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Side_effects\" class=\"mw-redirect\" title=\"Side effects\" rel=\"external_link\" target=\"_blank\">side effects<\/a> of medical treatment<\/li>\n<li><i>h<sub>t<\/sub><\/i> is the harm caused by the test itself.<\/li><\/ul>\n<p>Some additional factors that influence a decision whether a medical test should be performed or not included: cost of the test, availability of additional tests, potential interference with subsequent test (such as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominal_palpation\" class=\"mw-redirect\" title=\"Abdominal palpation\" rel=\"external_link\" target=\"_blank\">abdominal palpation<\/a> potentially inducing intestinal activity whose sounds interfere with a subsequent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominal_auscultation\" class=\"mw-redirect\" title=\"Abdominal auscultation\" rel=\"external_link\" target=\"_blank\">abdominal auscultation<\/a>), time taken for the test or other practical or administrative aspects. The possible benefits of a diagnostic test may also be weighed against the costs of unnecessary tests and resulting unnecessary follow-up and possibly even unnecessary treatment of incidental findings.<sup id=\"rdp-ebb-cite_ref-pmid12783911_16-0\" class=\"reference\"><a href=\"#cite_note-pmid12783911-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p><p>In some cases, tests being performed are expected to have no benefit for the individual being tested. Instead, the results may be useful for the establishment of statistics in order to improve health care for other individuals. Patients may give <a href=\"https:\/\/en.wikipedia.org\/wiki\/Informed_consent\" title=\"Informed consent\" rel=\"external_link\" target=\"_blank\">informed consent<\/a> to undergo medical tests that will benefit other people.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Standard_for_the_reporting_and_assessment\">Standard for the reporting and assessment<\/span><\/h2>\n<p>The QUADAS-2 revision is available.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 40em; -webkit-column-width: 40em; column-width: 40em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_culture\" title=\"Blood culture\" rel=\"external_link\" target=\"_blank\">Blood culture<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Chemical_test\" title=\"Chemical test\" rel=\"external_link\" target=\"_blank\">Chemical test<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gold_standard_(test)\" title=\"Gold standard (test)\" rel=\"external_link\" target=\"_blank\">Gold standard (test)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_sign\" title=\"Medical sign\" rel=\"external_link\" target=\"_blank\">Medical sign<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_diagnostics\" title=\"Molecular diagnostics\" rel=\"external_link\" target=\"_blank\">Molecular diagnostics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nailbed_assessment\" class=\"mw-redirect\" title=\"Nailbed assessment\" rel=\"external_link\" target=\"_blank\">Nailbed assessment<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Test_panel\" title=\"Test panel\" rel=\"external_link\" target=\"_blank\">Test panel<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Point-of-care_testing\" title=\"Point-of-care testing\" rel=\"external_link\" target=\"_blank\">Point-of-care testing<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes_and_references\">Notes and references<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-anc-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-anc_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-anc_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Al-Gwaiz LA, Babay HH (2007). \"The diagnostic value of absolute neutrophil count, band count and morphological changes of neutrophils in predicting bacterial infections\". <i>Med Princ Pract<\/i>. <b>16<\/b> (5): 344\u2013347. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1159%2F000104806\" target=\"_blank\">10.1159\/000104806<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17709921\" target=\"_blank\">17709921<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Med+Princ+Pract&rft.atitle=The+diagnostic+value+of+absolute+neutrophil+count%2C+band+count+and+morphological+changes+of+neutrophils+in+predicting+bacterial+infections&rft.volume=16&rft.issue=5&rft.pages=344-347&rft.date=2007&rft_id=info%3Adoi%2F10.1159%2F000104806&rft_id=info%3Apmid%2F17709921&rft.aulast=Al-Gwaiz&rft.aufirst=LA&rft.au=Babay%2C+HH&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+test\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.health.harvard.edu\/diagnostic-tests\/\" target=\"_blank\">Harvard.edu<\/a><br \/>Guide to Diagnostic Tests from Harvard Health<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.health.harvard.edu\/a_to_z\/electrocardiogram-ekg\" target=\"_blank\">Harvard.edu<\/a><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ratcliffe JM, Halperin WE, Frazier TM, Sundin DS, Delaney L, Hornung RW (1986). \"The prevalence of screening: a report from the National Institute of Occupational Safety and the Health National Occupational Hazard Survey\". <i>Journal of Occupational Medicine<\/i>. <b>28<\/b> (10): 906\u2013912. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00043764-198610000-00003\" target=\"_blank\">10.1097\/00043764-198610000-00003<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3021937\" target=\"_blank\">3021937<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Occupational+Medicine&rft.atitle=The+prevalence+of+screening%3A+a+report+from+the+National+Institute+of+Occupational+Safety+and+the+Health+National+Occupational+Hazard+Survey&rft.volume=28&rft.issue=10&rft.pages=906-912&rft.date=1986&rft_id=info%3Adoi%2F10.1097%2F00043764-198610000-00003&rft_id=info%3Apmid%2F3021937&rft.aulast=Ratcliffe&rft.aufirst=JM&rft.au=Halperin%2C+WE&rft.au=Frazier%2C+TM&rft.au=Sundin%2C+DS&rft.au=Delaney%2C+L&rft.au=Hornung%2C+RW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.osha.gov\/SLTC\/medicalsurveillance\/screening.html\" target=\"_blank\">Osha.gov<\/a><br \/>\nUS Dept. of Labor - Occupational Safety and Health Admin.<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Murthy LI, Halperin WE (1995). \"Medical Screening and Biological Monitoring: A guide to the literature for physicians\". <i>Journal of Occupational and Environmental Medicine<\/i>. <b>37<\/b> (2): 170\u2013184. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00043764-199502000-00016\" target=\"_blank\">10.1097\/00043764-199502000-00016<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7655958\" target=\"_blank\">7655958<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Occupational+and+Environmental+Medicine&rft.atitle=Medical+Screening+and+Biological+Monitoring%3A+A+guide+to+the+literature+for+physicians&rft.volume=37&rft.issue=2&rft.pages=170-184&rft.date=1995&rft_id=info%3Adoi%2F10.1097%2F00043764-199502000-00016&rft_id=info%3Apmid%2F7655958&rft.aulast=Murthy&rft.aufirst=LI&rft.au=Halperin%2C+WE&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Moltz KC, Postellon DC (1994). \"Congenital hypothyroidism and mental development\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Comprehensive_Therapy\" title=\"Comprehensive Therapy\" rel=\"external_link\" target=\"_blank\">Comprehensive Therapy<\/a><\/i>. <b>20<\/b> (6): 342\u2013346. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8062543\" target=\"_blank\">8062543<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Comprehensive+Therapy&rft.atitle=Congenital+hypothyroidism+and+mental+development&rft.volume=20&rft.issue=6&rft.pages=342-346&rft.date=1994&rft_id=info%3Apmid%2F8062543&rft.aulast=Moltz&rft.aufirst=KC&rft.au=Postellon%2C+DC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.opticsinfobase.org\/oe\/abstract.cfm?uri=oe-17-25-22423\" target=\"_blank\">OSA | Design of a high-sensor count fibre optic manometry catheter for in-vivo colonic diagnostics<\/a><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/eur-lex.europa.eu\/LexUriServ\/LexUriServ.do?uri=OJ:L:1998:331:0001:0037:EN:PDF\" target=\"_blank\">Directive 98\/79\/CE on in vitro diagnostic medical devices<\/a><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"#\/About-In-Vitro-Diagnostics\">[1]<\/a><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.labtestsonline.org.uk\/understanding\/analytes\/glucose\/tab\/test\" target=\"_blank\">Glucose Tests: The Test<\/a><\/span>\n<\/li>\n<li id=\"cite_note-labtestsonline.org.uk-12\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-labtestsonline.org.uk_12-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-labtestsonline.org.uk_12-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.labtestsonline.org.uk\/understanding\/analytes\/liver-panel\/\" target=\"_blank\">Liver Function Tests: At a Glance<\/a><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.labtestsonline.org.uk\/understanding\/analytes\/lytes\" target=\"_blank\">Electrolytes: At a Glance<\/a><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.health.harvard.edu\/diagnostic-tests\/mediastinoscopy.htm\" target=\"_blank\">Harvard.edu<\/a><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070608072504\/http:\/\/www.health.harvard.edu\/diagnostic-tests\/pap-smear.htm\" target=\"_blank\"><i>Diagnostic Tests > Pap Smear<\/i><\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harvard_University\" title=\"Harvard University\" rel=\"external_link\" target=\"_blank\">Harvard University<\/a>, archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.health.harvard.edu\/diagnostic-tests\/pap-smear.htm\" target=\"_blank\">the original<\/a> on June 8, 2007<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Diagnostic+Tests+%3E+Pap+Smear&rft.pub=Harvard+University&rft_id=http%3A%2F%2Fwww.health.harvard.edu%2Fdiagnostic-tests%2Fpap-smear.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid12783911-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid12783911_16-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jarvik J, Hollingworth W, Martin B, Emerson S, Gray D, Overman S, Robinson D, Staiger T, Wessbecher F, Sullivan S, Kreuter W, Deyo R (2003). \"Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial\". <i>JAMA<\/i>. <b>289<\/b> (21): 2810\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Fjama.289.21.2810\" target=\"_blank\">10.1001\/jama.289.21.2810<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12783911\" target=\"_blank\">12783911<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JAMA&rft.atitle=Rapid+magnetic+resonance+imaging+vs+radiographs+for+patients+with+low+back+pain%3A+a+randomized+controlled+trial&rft.volume=289&rft.issue=21&rft.pages=2810-8&rft.date=2003&rft_id=info%3Adoi%2F10.1001%2Fjama.289.21.2810&rft_id=info%3Apmid%2F12783911&rft.aulast=Jarvik&rft.aufirst=J&rft.au=Hollingworth%2C+W&rft.au=Martin%2C+B&rft.au=Emerson%2C+S&rft.au=Gray%2C+D&rft.au=Overman%2C+S&rft.au=Robinson%2C+D&rft.au=Staiger%2C+T&rft.au=Wessbecher%2C+F&rft.au=Sullivan%2C+S&rft.au=Kreuter%2C+W&rft.au=Deyo%2C+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Whiting, Penny F.; Anne W.S. Rutjes; Marie E. Westwood; Susan Mallett; Jonathan J. Deeks; Johannes B. Reitsma; Mariska M.G. Leeflang; Jonathan A.C. Sterne; Patrick M.M. Bossuyt; QUADAS-2 Group (2011-10-18). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120211100230\/http:\/\/www.annals.org\/content\/155\/8\/529.abstract\" target=\"_blank\">\"QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies\"<\/a>. <i>Annals of Internal Medicine<\/i>. <b>155<\/b> (8): 529\u2013536. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.7326%2F0003-4819-155-8-201110180-00009\" target=\"_blank\">10.7326\/0003-4819-155-8-201110180-00009<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.annals.org\/content\/155\/8\/529.abstract\" target=\"_blank\">the original<\/a> on 2012-02-11<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-10-18<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Internal+Medicine&rft.atitle=QUADAS-2%3A+A+Revised+Tool+for+the+Quality+Assessment+of+Diagnostic+Accuracy+Studies&rft.volume=155&rft.issue=8&rft.pages=529-536&rft.date=2011-10-18&rft_id=info%3Adoi%2F10.7326%2F0003-4819-155-8-201110180-00009&rft.aulast=Whiting&rft.aufirst=Penny+F.&rft.au=Anne+W.S.+Rutjes&rft.au=Marie+E.+Westwood&rft.au=Susan+Mallett&rft.au=Jonathan+J.+Deeks&rft.au=Johannes+B.+Reitsma&rft.au=Mariska+M.G.+Leeflang&rft.au=Jonathan+A.C.+Sterne&rft.au=Patrick+M.M.+Bossuyt&rft.au=QUADAS-2+Group&rft_id=http%3A%2F%2Fwww.annals.org%2Fcontent%2F155%2F8%2F529.abstract&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n\n\n\n\n\n\n\n\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1254\nCached time: 20181202064615\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.496 seconds\nReal time usage: 0.649 seconds\nPreprocessor visited node count: 1902\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 208417\/2097152 bytes\nTemplate argument size: 529\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 26201\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.173\/10.000 seconds\nLua memory usage: 4.39 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 386.575 1 -total\n<\/p>\n<pre>35.97% 139.044 1 Template:Reflist\n28.85% 111.545 6 Template:Cite_journal\n27.11% 104.783 21 Template:Navbox\n18.49% 71.482 1 Template:Infobox_interventions\n16.68% 64.482 1 Template:Infobox\n 6.57% 25.394 1 Template:Medical_imaging\n 5.20% 20.113 3 Template:Main\n 4.93% 19.075 1 Template:Myeloid_blood_tests\n 3.86% 14.926 1 Template:Col_div\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:12439068-1!canonical!math=5 and timestamp 20181202064615 and revision id 863479577\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_test\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214712\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.018 seconds\nReal time usage: 0.169 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 158.992 1 - wikipedia:Medical_test\n100.00% 158.992 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8206-0!*!*!*!*!*!* and timestamp 20181217214712 and revision id 24356\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_test\">https:\/\/www.limswiki.org\/index.php\/Medical_test<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","0e5a509a721423b5cae83265bbb80c85_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/fb\/X-ray_by_Wilhelm_R%C3%B6ntgen_of_Albert_von_K%C3%B6lliker%27s_hand_-_18960123-02.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/85\/Lung_scintigraphy_keosys.JPG\/440px-Lung_scintigraphy_keosys.JPG"],"0e5a509a721423b5cae83265bbb80c85_timestamp":1545083232,"1148193934d4fb36855d27dfafd5c25a_type":"article","1148193934d4fb36855d27dfafd5c25a_title":"Medical\u2013industrial complex","1148193934d4fb36855d27dfafd5c25a_url":"https:\/\/www.limswiki.org\/index.php\/Medical%E2%80%93industrial_complex","1148193934d4fb36855d27dfafd5c25a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMedical\u2013industrial complex\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Medical equipment and devices\nThe medical\u2013industrial complex is the network of corporations which supply health care services and products for a profit. The term is analogous to \"military\u2013industrial complex\" and builds from the social precedent of discussion on that concept.\nThe medical\u2013industrial complex is often discussed in the context of conflict of interest in the health care industry.\n\nContents \n\n1 Term \n2 Characteristics \n3 References \n4 Further reading \n\n\nTerm \nThe concept of a \"medical\u2013industrial complex\" was first advanced by Barbara and John Ehrenreich in the November 1969 issue of the Bulletin of the Health Policy Advisory Center in an article entitled \"The Medical Industrial Complex\" and in a subsequent book (with Health-PAC), The American Health Empire: Power, Profits, and Politics (Random House, 1970). The concept was widely discussed throughout the 1970s, including reviews in the New England Journal of Medicine (November 4, 1971, 285:1095). It was further popularized in 1980, Arnold S. Relman while he served as editor of The New England Journal of Medicine.[1] in a paper titled \"The New Medical-Industrial Complex.\" Relman commented, \"The past decade has seen the rise of another kind of private \"industrial complex\" with an equally great potential for influence on public policy \u2014 this time in health care...\" Oddly, Relman added, \" In searching for information on this subject, I have found no standard literature and have had to draw on a variety of unconventional sources...\"[1] Subsequently, this paper and the concept have been discussed continually.[2] An updated history and analysis can be found in John Ehrenreich, \"Third Wave Capitalism: How Money, Power, and the Pursuit of Self-Interest have Imperiled the American Dream\" (Cornell University Press, May 2016).\n\nCharacteristics \nManufacturers of medical devices fund medical education programs and physicians and hospitals directly to adopt the use of their devices.[3]\nThe management of health care organizations by business staff rather than local medical practice is one of the trends of the increasing influence of the medical-industrial complex.[4]\nAnother trend is that increased pressure to generate profit for providing services can decrease the influence of creativity or innovation in medical research.[5]\nIn the 1970s profit-seeking companies became significant stakeholders in the United States healthcare system.[6]\nThe influence of economic policy on the practice of medicine has a long history.[7]\nBecause the General Agreement on Trade in Services regulates international marketplaces, in countries where the industrial-medical complex is more strong there can be legal limitations to consumer options for accessing diverse healthcare services.[8]\nBecause the industrial-medical complex funds continuing medical education, this education has a bias to promote the interests of its funders.[9]\n\nReferences \n\n\n^ a b Relman, Arnold S. (1980). \"The New Medical-Industrial Complex\". New England Journal of Medicine. 303 (17): 963\u2013970. doi:10.1056\/NEJM198010233031703. ISSN 0028-4793. \n\n^ Malina, Debra; Rosenbaum, Lisa (2015). \"Understanding Bias \u2014 The Case for Careful Study\". New England Journal of Medicine. 372 (20): 1959\u20131963. doi:10.1056\/NEJMms1502497. ISSN 0028-4793. PMID 25970055. \n\n^ Baggish, Michaels.; Nezhat, Camran (1992). \"The Medical\u2013Industrial Complex\". Journal of Gynecologic Surgery. 8 (3): v\u2013vi. doi:10.1089\/gyn.1992.8.v. ISSN 1042-4067. \n\n^ Maloney, FP (1998). \"The emerging medical\/industrial complex. The industrialization of medicine\". Physician Executive. 24 (2): 34\u20138. PMID 10180498. \n\n^ Stevens, CW; Glatstein, E (1996). \"Beware the Medical-Industrial Complex\". The Oncologist. 1 (4): IV\u2013V. PMID 10388005. \n\n^ Buchanan, Robert J. (Winter 1982). \"The Financial Status of the New Medical-Industrial Complex\". Inquiry. 19 (4): 308\u2013316. JSTOR 29771516. \n\n^ Jupiter, Jesse; Burke, Dennis (2013). \"Scott's parabola and the rise of the medical\u2013industrial complex\". HAND. 8 (3): 249\u2013252. doi:10.1007\/s11552-013-9526-5. ISSN 1558-9447. PMC 3745238 . \n\n^ Santos, MA; Passos, SR (August 2010). \"[International trade in health services and the medical industrial complex: implications for national health systems]\". Cadernos de Sa\u00fade P\u00fablica. 26 (8): 1483\u201393. PMID 21229208. \n\n^ Schofferman, Jerome (2011). \"The Medical-Industrial Complex, Professional Medical Associations, and Continuing Medical Education\". Pain Medicine. 12 (12): 1713\u20131719. doi:10.1111\/j.1526-4637.2011.01282.x. ISSN 1526-2375. \n\n\nFurther reading \nGeyman, John P. (2004-01-01). The Corporate Transformation of Health Care: Can the Public Interest Still Be Served?. Springer Publishing Company. ISBN 9780826124678. Retrieved 2015-05-14 . \nSchatman, Michael E. (2011). \"The Medical-Industrial Complex and Conflict of Interest in Pain Education\". Pain Medicine. 12 (12): 1710\u20131712. doi:10.1111\/j.1526-4637.2011.01284.x. ISSN 1526-2375. \nRosenthal, Elisabeth (2017). An American Sickness: How Healthcare Became Big Business and How You Can Take it Back. Penguin Press. ISBN 9780698407183. \n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical%E2%80%93industrial_complex\">https:\/\/www.limswiki.org\/index.php\/Medical%E2%80%93industrial_complex<\/a>\n\t\t\t\t\tCategories: Economic termsHealthcare termsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 21:00.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,130 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","1148193934d4fb36855d27dfafd5c25a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Medical\u2013industrial_complex skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Medical\u2013industrial complex<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Beth-El_Industries_Isolation_chamber_inside_view.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fc\/Beth-El_Industries_Isolation_chamber_inside_view.jpg\/220px-Beth-El_Industries_Isolation_chamber_inside_view.jpg\" width=\"220\" height=\"294\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Beth-El_Industries_Isolation_chamber_inside_view.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Medical equipment and devices<\/div><\/div><\/div>\n<p>The <b>medical\u2013industrial complex<\/b> is the network of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corporations\" class=\"mw-redirect\" title=\"Corporations\" rel=\"external_link\" target=\"_blank\">corporations<\/a> which supply <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care\" title=\"Health care\" rel=\"external_link\" target=\"_blank\">health care<\/a> services and products for a profit. The term is analogous to \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Military%E2%80%93industrial_complex\" title=\"Military\u2013industrial complex\" rel=\"external_link\" target=\"_blank\">military\u2013industrial complex<\/a>\" and builds from the social precedent of discussion on that concept.\n<\/p><p>The medical\u2013industrial complex is often discussed in the context of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Conflict_of_interest_in_the_health_care_industry\" class=\"mw-redirect\" title=\"Conflict of interest in the health care industry\" rel=\"external_link\" target=\"_blank\">conflict of interest in the health care industry<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Term\">Term<\/span><\/h2>\n<p>The concept of a \"medical\u2013industrial complex\" was first advanced by Barbara and John Ehrenreich in the November 1969 issue of the Bulletin of the Health Policy Advisory Center in an article entitled \"The Medical Industrial Complex\" and in a subsequent book (with Health-PAC), The American Health Empire: Power, Profits, and Politics (Random House, 1970). The concept was widely discussed throughout the 1970s, including reviews in the New England Journal of Medicine (November 4, 1971, 285:1095). It was further popularized in 1980, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arnold_S._Relman\" title=\"Arnold S. Relman\" rel=\"external_link\" target=\"_blank\">Arnold S. Relman<\/a> while he served as editor of <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_New_England_Journal_of_Medicine\" title=\"The New England Journal of Medicine\" rel=\"external_link\" target=\"_blank\">The New England Journal of Medicine<\/a><\/i>.<sup id=\"rdp-ebb-cite_ref-Relman1980_1-0\" class=\"reference\"><a href=\"#cite_note-Relman1980-1\" rel=\"external_link\">[1]<\/a><\/sup> in a paper titled \"The New Medical-Industrial Complex.\" Relman commented, \"The past decade has seen the rise of another kind of private \"industrial complex\" with an equally great potential for influence on public policy \u2014 this time in health care...\" Oddly, Relman added, \" In searching for information on this subject, I have found no standard literature and have had to draw on a variety of unconventional sources...\"<sup id=\"rdp-ebb-cite_ref-Relman1980_1-1\" class=\"reference\"><a href=\"#cite_note-Relman1980-1\" rel=\"external_link\">[1]<\/a><\/sup> Subsequently, this paper and the concept have been discussed continually.<sup id=\"rdp-ebb-cite_ref-MalinaRosenbaum2015_2-0\" class=\"reference\"><a href=\"#cite_note-MalinaRosenbaum2015-2\" rel=\"external_link\">[2]<\/a><\/sup> An updated history and analysis can be found in John Ehrenreich, \"Third Wave Capitalism: How Money, Power, and the Pursuit of Self-Interest have Imperiled the American Dream\" (Cornell University Press, May 2016).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Characteristics\">Characteristics<\/span><\/h2>\n<p>Manufacturers of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical devices<\/a> fund medical education programs and physicians and hospitals directly to adopt the use of their devices.<sup id=\"rdp-ebb-cite_ref-BaggishNezhat1992_3-0\" class=\"reference\"><a href=\"#cite_note-BaggishNezhat1992-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>The management of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care_organization\" class=\"mw-redirect\" title=\"Health care organization\" rel=\"external_link\" target=\"_blank\">health care organizations<\/a> by business staff rather than local medical practice is one of the trends of the increasing influence of the medical-industrial complex.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>Another trend is that increased pressure to generate profit for providing services can decrease the influence of creativity or innovation in medical research.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>In the 1970s profit-seeking companies became significant stakeholders in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care_in_the_United_States\" title=\"Health care in the United States\" rel=\"external_link\" target=\"_blank\">United States healthcare<\/a> system.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>The influence of economic policy on the practice of medicine has a long history.<sup id=\"rdp-ebb-cite_ref-JupiterBurke2013_7-0\" class=\"reference\"><a href=\"#cite_note-JupiterBurke2013-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>Because the <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_Agreement_on_Trade_in_Services\" title=\"General Agreement on Trade in Services\" rel=\"external_link\" target=\"_blank\">General Agreement on Trade in Services<\/a> regulates international marketplaces, in countries where the industrial-medical complex is more strong there can be legal limitations to consumer options for accessing diverse healthcare services.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p><p>Because the industrial-medical complex funds <a href=\"https:\/\/en.wikipedia.org\/wiki\/Continuing_medical_education\" title=\"Continuing medical education\" rel=\"external_link\" target=\"_blank\">continuing medical education<\/a>, this education has a bias to promote the interests of its funders.<sup id=\"rdp-ebb-cite_ref-Schofferman2011_9-0\" class=\"reference\"><a href=\"#cite_note-Schofferman2011-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Relman1980-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Relman1980_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Relman1980_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Relman, Arnold S. (1980). \"The New Medical-Industrial Complex\". <i>New England Journal of Medicine<\/i>. <b>303<\/b> (17): 963\u2013970. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2FNEJM198010233031703\" target=\"_blank\">10.1056\/NEJM198010233031703<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0028-4793\" target=\"_blank\">0028-4793<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=New+England+Journal+of+Medicine&rft.atitle=The+New+Medical-Industrial+Complex&rft.volume=303&rft.issue=17&rft.pages=963-970&rft.date=1980&rft_id=info%3Adoi%2F10.1056%2FNEJM198010233031703&rft.issn=0028-4793&rft.aulast=Relman&rft.aufirst=Arnold+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-MalinaRosenbaum2015-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MalinaRosenbaum2015_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Malina, Debra; Rosenbaum, Lisa (2015). \"Understanding Bias \u2014 The Case for Careful Study\". <i>New England Journal of Medicine<\/i>. <b>372<\/b> (20): 1959\u20131963. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2FNEJMms1502497\" target=\"_blank\">10.1056\/NEJMms1502497<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0028-4793\" target=\"_blank\">0028-4793<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25970055\" target=\"_blank\">25970055<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=New+England+Journal+of+Medicine&rft.atitle=Understanding+Bias+%E2%80%94+The+Case+for+Careful+Study&rft.volume=372&rft.issue=20&rft.pages=1959-1963&rft.date=2015&rft.issn=0028-4793&rft_id=info%3Apmid%2F25970055&rft_id=info%3Adoi%2F10.1056%2FNEJMms1502497&rft.aulast=Malina&rft.aufirst=Debra&rft.au=Rosenbaum%2C+Lisa&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-BaggishNezhat1992-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-BaggishNezhat1992_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Baggish, Michaels.; Nezhat, Camran (1992). \"The Medical\u2013Industrial Complex\". <i>Journal of Gynecologic Surgery<\/i>. <b>8<\/b> (3): v\u2013vi. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1089%2Fgyn.1992.8.v\" target=\"_blank\">10.1089\/gyn.1992.8.v<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1042-4067\" target=\"_blank\">1042-4067<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Gynecologic+Surgery&rft.atitle=The+Medical%E2%80%93Industrial+Complex&rft.volume=8&rft.issue=3&rft.pages=v-vi&rft.date=1992&rft_id=info%3Adoi%2F10.1089%2Fgyn.1992.8.v&rft.issn=1042-4067&rft.aulast=Baggish&rft.aufirst=Michaels.&rft.au=Nezhat%2C+Camran&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Maloney, FP (1998). \"The emerging medical\/industrial complex. The industrialization of medicine\". <i>Physician Executive<\/i>. <b>24<\/b> (2): 34\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10180498\" target=\"_blank\">10180498<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Physician+Executive&rft.atitle=The+emerging+medical%2Findustrial+complex.+The+industrialization+of+medicine.&rft.volume=24&rft.issue=2&rft.pages=34-8&rft.date=1998&rft_id=info%3Apmid%2F10180498&rft.aulast=Maloney&rft.aufirst=FP&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stevens, CW; Glatstein, E (1996). \"Beware the Medical-Industrial Complex\". <i>The Oncologist<\/i>. <b>1<\/b> (4): IV\u2013V. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10388005\" target=\"_blank\">10388005<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Oncologist&rft.atitle=Beware+the+Medical-Industrial+Complex.&rft.volume=1&rft.issue=4&rft.pages=IV-V&rft.date=1996&rft_id=info%3Apmid%2F10388005&rft.aulast=Stevens&rft.aufirst=CW&rft.au=Glatstein%2C+E&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Buchanan, Robert J. (Winter 1982). \"The Financial Status of the New Medical-Industrial Complex\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Inquiry_(health_journal)\" title=\"Inquiry (health journal)\" rel=\"external_link\" target=\"_blank\">Inquiry<\/a><\/i>. <b>19<\/b> (4): 308\u2013316. <a href=\"https:\/\/en.wikipedia.org\/wiki\/JSTOR\" title=\"JSTOR\" rel=\"external_link\" target=\"_blank\">JSTOR<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.jstor.org\/stable\/29771516\" target=\"_blank\">29771516<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Inquiry&rft.atitle=The+Financial+Status+of+the+New+Medical-Industrial+Complex&rft.ssn=winter&rft.volume=19&rft.issue=4&rft.pages=308-316&rft.date=1982&rft_id=%2F%2Fwww.jstor.org%2Fstable%2F29771516&rft.aulast=Buchanan&rft.aufirst=Robert+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-JupiterBurke2013-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-JupiterBurke2013_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jupiter, Jesse; Burke, Dennis (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3745238\" target=\"_blank\">\"Scott's parabola and the rise of the medical\u2013industrial complex\"<\/a>. <i>HAND<\/i>. <b>8<\/b> (3): 249\u2013252. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11552-013-9526-5\" target=\"_blank\">10.1007\/s11552-013-9526-5<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1558-9447\" target=\"_blank\">1558-9447<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3745238\" target=\"_blank\">3745238<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=HAND&rft.atitle=Scott%E2%80%99s+parabola+and+the+rise+of+the+medical%E2%80%93industrial+complex&rft.volume=8&rft.issue=3&rft.pages=249-252&rft.date=2013&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3745238&rft.issn=1558-9447&rft_id=info%3Adoi%2F10.1007%2Fs11552-013-9526-5&rft.aulast=Jupiter&rft.aufirst=Jesse&rft.au=Burke%2C+Dennis&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3745238&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Santos, MA; Passos, SR (August 2010). \"[International trade in health services and the medical industrial complex: implications for national health systems]\". <i>Cadernos de Sa\u00fade P\u00fablica<\/i>. <b>26<\/b> (8): 1483\u201393. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21229208\" target=\"_blank\">21229208<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cadernos+de+Sa%C3%BAde+P%C3%BAblica&rft.atitle=%5BInternational+trade+in+health+services+and+the+medical+industrial+complex%3A+implications+for+national+health+systems%5D.&rft.volume=26&rft.issue=8&rft.pages=1483-93&rft.date=2010-08&rft_id=info%3Apmid%2F21229208&rft.aulast=Santos&rft.aufirst=MA&rft.au=Passos%2C+SR&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Schofferman2011-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Schofferman2011_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Schofferman, Jerome (2011). \"The Medical-Industrial Complex, Professional Medical Associations, and Continuing Medical Education\". <i>Pain Medicine<\/i>. <b>12<\/b> (12): 1713\u20131719. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1526-4637.2011.01282.x\" target=\"_blank\">10.1111\/j.1526-4637.2011.01282.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1526-2375\" target=\"_blank\">1526-2375<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pain+Medicine&rft.atitle=The+Medical-Industrial+Complex%2C+Professional+Medical+Associations%2C+and+Continuing+Medical+Education&rft.volume=12&rft.issue=12&rft.pages=1713-1719&rft.date=2011&rft_id=info%3Adoi%2F10.1111%2Fj.1526-4637.2011.01282.x&rft.issn=1526-2375&rft.aulast=Schofferman&rft.aufirst=Jerome&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation book\">Geyman, John P. (2004-01-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=rL_DbHkZQnwC&printsec=frontcover&dq=medical+corporations+health+care&hl=en&sa=X&ei=4eNUVaK0LsOggwSN1YGoCw&ved=0CDUQ6AEwAQ#v=onepage&q=medical%20corporations%20health%20care&f=false\" target=\"_blank\"><i>The Corporate Transformation of Health Care: Can the Public Interest Still Be Served?<\/i><\/a>. Springer Publishing Company. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780826124678<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-05-14<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Corporate+Transformation+of+Health+Care%3A+Can+the+Public+Interest+Still+Be+Served%3F&rft.pub=Springer+Publishing+Company&rft.date=2004-01-01&rft.isbn=9780826124678&rft.aulast=Geyman&rft.aufirst=John+P.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DrL_DbHkZQnwC%26printsec%3Dfrontcover%26dq%3Dmedical%2Bcorporations%2Bhealth%2Bcare%26hl%3Den%26sa%3DX%26ei%3D4eNUVaK0LsOggwSN1YGoCw%26ved%3D0CDUQ6AEwAQ%23v%3Donepage%26q%3Dmedical%2520corporations%2520health%2520care%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Schatman, Michael E. (2011). \"The Medical-Industrial Complex and Conflict of Interest in Pain Education\". <i>Pain Medicine<\/i>. <b>12<\/b> (12): 1710\u20131712. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1526-4637.2011.01284.x\" target=\"_blank\">10.1111\/j.1526-4637.2011.01284.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1526-2375\" target=\"_blank\">1526-2375<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pain+Medicine&rft.atitle=The+Medical-Industrial+Complex+and+Conflict+of+Interest+in+Pain+Education&rft.volume=12&rft.issue=12&rft.pages=1710-1712&rft.date=2011&rft_id=info%3Adoi%2F10.1111%2Fj.1526-4637.2011.01284.x&rft.issn=1526-2375&rft.aulast=Schatman&rft.aufirst=Michael+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Rosenthal, Elisabeth (2017). <i>An American Sickness: How Healthcare Became Big Business and How You Can Take it Back<\/i>. Penguin Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780698407183.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=An+American+Sickness%3A+How+Healthcare+Became+Big+Business+and+How+You+Can+Take+it+Back&rft.pub=Penguin+Press&rft.date=2017&rft.isbn=9780698407183&rft.aulast=Rosenthal&rft.aufirst=Elisabeth&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMedical%E2%80%93industrial+complex\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1264\nCached time: 20181210143947\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.196 seconds\nReal time usage: 0.238 seconds\nPreprocessor visited node count: 565\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 22612\/2097152 bytes\nTemplate argument size: 92\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 30352\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.136\/10.000 seconds\nLua memory usage: 3.79 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 200.037 1 -total\n<\/p>\n<pre>91.90% 183.835 1 Template:Reflist\n84.88% 169.789 10 Template:Cite_journal\n 4.86% 9.719 2 Template:Cite_book\n 1.43% 2.864 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:46704707-1!canonical and timestamp 20181210143947 and revision id 841426502\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical%E2%80%93industrial_complex\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214712\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.164 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 157.821 1 - wikipedia:Medical\u2013industrial_complex\n100.00% 157.821 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8577-0!*!*!*!*!*!* and timestamp 20181217214711 and revision id 25005\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical%E2%80%93industrial_complex\">https:\/\/www.limswiki.org\/index.php\/Medical%E2%80%93industrial_complex<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","1148193934d4fb36855d27dfafd5c25a_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/fc\/Beth-El_Industries_Isolation_chamber_inside_view.jpg"],"1148193934d4fb36855d27dfafd5c25a_timestamp":1545083231,"94d576c5d095ff5b727c95343fde5efa_type":"article","94d576c5d095ff5b727c95343fde5efa_title":"Medical equipment management","94d576c5d095ff5b727c95343fde5efa_url":"https:\/\/www.limswiki.org\/index.php\/Medical_equipment_management","94d576c5d095ff5b727c95343fde5efa_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMedical equipment management\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these template messages)\n\n This article may require cleanup to meet Wikipedia's quality standards. No cleanup reason has been specified. Please help improve this article if you can. (December 2011) (Learn how and when to remove this template message)\nThis article includes a list of references, related reading or external links, but its sources remain unclear because it lacks inline citations. Please help to improve this article by introducing more precise citations. (March 2016) (Learn how and when to remove this template message)\n \n (Learn how and when to remove this template message)\nHealthcare Technology Management (sometimes referred to as clinical engineering, clinical engineering management, clinical technology management, healthcare technology management, medical equipment management, biomedical maintenance, biomedical equipment management, and biomedical engineering) is a term for the professionals who manage operations, analyze and improve utilization and safety, and support servicing healthcare technology. These healthcare technology managers are, much like other healthcare professionals referred to by various specialty or organizational hierarchy names.\nSome of the titles of healthcare technology management professionals are biomed, biomedical equipment technician, biomedical engineering technician, biomedical engineer, BMET, biomedical equipment management, biomedical equipment services, imaging service engineer, imaging specialist, clinical engineer technician, clinical engineering equipment technician, field service engineer, field clinical engineer, clinical engineer, and medical equipment repair person. Regardless of the various titles, these professionals offer services within and outside of healthcare settings to enhance the safety, utilization, and performance on medical devices, applications, and systems.\nThey are a fundamental part of managing, maintaining, and\/or designing medical devices, applications, and systems for use in various healthcare settings, from the home and the field to the doctor's office and the hospital.\nHTM includes the business processes used in interaction and oversight of the technology involved in the diagnosis, treatment, and monitoring of patients. The related policies and procedures govern activities such as the selection, planning, and acquisition of medical devices, and the inspection, acceptance, maintenance, and eventual retirement and disposal of medical equipment. \n\nContents \n\n1 Responsibilities of the Healthcare Technology Management Professional \n2 Equipment Control & Asset Management \n3 Work Order Management \n4 Data Quality Management \n5 Quality Assurance \n6 Patient Safety \n7 Risk management \n8 Hospital Safety Programs \n9 References \n\n\nResponsibilities of the Healthcare Technology Management Professional \nThe healthcare technology management professional's purpose is to ensure that equipment and systems used in patient care are operational, safe, and properly configured to meet the mission of the healthcare; that the equipment is used in an effective way consistent with the highest standards of care by educating the healthcare provider, equipment user, and patient; that the equipment is designed to limit the potential for loss, harm, or damage to the patient, provider, visitor, and facilities through various means of analysis prior to and during acquisition, monitoring and foreseeing problems during the lifecycle of the equipment, and collaborating with the parties who manufacture, design, regulate, or recommend safe medical devices and systems.\nSome but not all of the healthcare technology management professional's functions are:\n\nEquipment Control & Asset Management\nEquipment Inventories\nWork Order Management\nData Quality Management\nEquipment Maintenance Management\nEquipment Maintenance\nPersonnel Management\nQuality Assurance\nPatient Safety\nRisk Management\nHospital Safety Programs\nRadiation Safety\nMedical Gas Systems\nIn-Service Education & Training\nAccident Investigation\nAnalysis of Failures, Root Causes, and Human Factors\nSafe Medical Devices Act (SMDA) of 1990\nHealth Insurance Portability and Accountability Act (HIPAA)\nCareers in Facilities Management\n Equipment Control & Asset Management \nEvery medical treatment facility should have policies and processes on equipment control and asset management. Equipment control and asset management involves the management of medical devices within a facility and may be supported by automated information systems (e.g., enterprise resource planning (ERP) systems are often found in U.S. hospitals, and the U.S. military health system uses an advanced automated system known as the Defense Medical Logistics Standard Support (DMLSS) suite of applications) or may use a dedicated equipment management and maintenance software (e.g., BME Assistor). Equipment control begins with the receipt of a newly acquired equipment item and continues through the item's entire lifecycle. Newly acquired devices should be inspected by in-house or contracted biomedical equipment technicians (BMETs), who will receive an established equipment control\/asset number from the facilities equipment\/property manager. This control number is used to track and record maintenance actions in their database. This is similar to creating a new chart for a new patient who will be seen at the medical facility. Once an equipment control number is established, the device is safety inspected and readied for delivery to clinical and treatment areas in the facility. \nFacilities or healthcare delivery networks may rely on a combination of equipment service providers such as manufacturers, third-party services, in-house technicians, and remote support. Equipment managers are responsible for continuous oversight and responsibility for ensuring safe and effective equipment performance through full-service maintenance. Medical equipment managers are also responsible for technology assessment, planning and management in all areas within a medical treatment facility (e.g. developing policies and procedures for the medical equipment management plan, identifying trends and the need for staff education, resolution of defective biomedical equipment issues).\nThis industry is new, and there is not a clear line between IT and Bio-Med.\n\nWork Order Management \nWork order management involves systematic, measurable, and traceable methods to all acceptance\/initial inspections, preventive maintenance, and calibrations, or repairs by generating scheduled and unscheduled work orders. Work order management may be paper-based or computer-base and includes the maintenance of active (open or uncompleted) and completed work orders which provide a comprehensive maintenance history of all medical equipment devices used in the diagnosis, treatment, and management of patients. Work order management includes all safety, preventive, calibration, test, and repair services performed on all such medical devices. A comprehensive work order management system can also be used as a resource and workload management tool by managers responsible for personnel time, total number of hour\u2019s technician spent working on equipment, maximum repair dollar for one time repair, or total dollar allowed to spend repairing equipment versus replacement.\nPost-work order quality checks involve one of two methods: 100% audit of all work orders or statistical sampling of randomly selected work orders. Randomly selected work orders should place more stringent statistical controls based on the clinical criticality of the device involved. For example, 100% of items critical to patient treatment but only 50% of ancillary items may be selected for sampling. In an ideal setting, all work orders are checked, but available resources may dictate a less comprehensive approach. Work orders must be tracked regularly and all discrepancies must be corrected. Managers are responsible to identify equipment location\n\nData Quality Management \nAccurate, comprehensive data are needed in any automated medical equipment management system. Data quality initiatives can help to insure the accuracy of clinical\/biomedical engineering data. The data needed to establish basic, accurate, maintainable automated records for medical equipment management includes: nomenclature, manufacturer, nameplate model, serial number, acquisition cost, condition code, and maintenance assessment. Other useful data could include: warranty, location, other contractor agencies, scheduled maintenance due dates, and intervals. These fields are vital to ensure appropriate maintenance is performed, equipment is accounted for, and devices are safe for use in patient care.\n\nNomenclature: It defines what the device is, how, and the type of maintenance is to be performed. Common nomenclature systems are taken directly from the ECRI Institute Universal Medical Device Nomenclature System.\nManufacturer: This is the name of the company that received approval from the FDA to sell the device, also known as the Original Equipment Manufacturer (OEM).\nNameplate model: The model number is typically located on the front\/behind of the equipment or on the cover of the service manual and is provided by the OEM. E.g. Medtronic PhysioControl\u2019s Lifepak 10 Defibrillator can actually be any one of the following correct model numbers listed: 10-41, 10-43, 10 -47, 10-51, and 10-57.\nSerial number: This is usually found on the data plate as well, is a serialized number (could contain alpha characters) provided by the manufacturer. This number is crucial to device alerts and recalls.\nAcquisition cost: The total purchased price for an individual item or system. This cost should include installation, shipping, and other associated costs. These numbers are crucial for budgeting, maintenance expenditures, and depreciation reporting.\nCondition code: This code is mainly used when an item is turned in and should be changed when there are major changes to the device that could affect whether or not an item should be salvaged, destroyed, or used by another Medical Treatment Facility.\nMaintenance assessment: This assessment must be validated every time a BMET performs any kind of maintenance on a device.\nSeveral other management tools, such as equipment replacement planning and budgeting, depreciation calculations, and at the local level literature, repair parts, and supplies are directly related to one or more of these fundamental basics. Data Quality must be tracked monthly and all discrepancies must be corrected.\n\nQuality Assurance \nQuality Assurance is a way of identifying an item of supply or equipment as being defective. A good quality control\/engineering program improves quality of work and lessens the risk of staff\/patient injuries\/death.\n\nPatient Safety \nSafety of our patients\/staff is paramount to the success of our organizations mission. The Joint Commission publishes annual lists detailing \u201cNational Patient Safety Goals\u201d to be implemented by healthcare organizations. Goals are developed by experts in patient safety nurses, physicians, pharmacists, risk managers, and other professionals with patient-safety experience in a variety of settings. Patient safety is among the most important goals of every healthcare provider, and participation in a variety of committees and processes concerned with patient safety provides a way for biomedical managers and clinical engineering departments to gain visibility and positively affect their workplace.\n\nRisk management \nThis program helps the medical treatment facility avoid the likelihood of equipment-related risks, minimize liability of mishaps and incidents, and stay compliant with regulatory reporting requirements. The best practice is to use a rating system for every equipment type. For example, a risk-rating system might rate defibrillators as considered high risk, general-purpose infusion pumps as medium risk, electronic thermometers as low risk, and otoscopes as no significant risk. This system could be set up using Microsoft Excel or Access program for a manager's or technician's quick reference.\nIn addition, user error, equipment abuse, no problem\/fault found occurrences must be tracked to assist risk management personnel in determining whether additional clinical staff training must be performed.\nRisk management for IT networks incorporating medical devices will be covered by the standard ISO\/IEC 80001. Its purpose is: \"Recognizing that MEDICAL DEVICES are incorporated into IT-NETWORKS to achieve desirable benefits (for example, INTEROPERABILITY), this international standard defines the roles, responsibilities and activities that are necessary for RISK MANAGEMENT of IT-NETWORKS incorporating MEDICAL DEVICES to address the KEY PROPERTIES\". It resorts some basic ideas of ISO 20000 in the context of medical applications, e.g. configuration, incident, problem, change and release management, and risk analysis, control and evaluation according to ISO 14971. IEC 80001 \"applies to RESPONSIBLE ORGANIZATIONS, MEDICAL DEVICE manufacturers and other providers of information technologies for the purpose of comprehensive RISK MANAGEMENT\".\n\nHospital Safety Programs \nThe Joint Commission stipulates seven management plans for hospital accreditation. One of the seven is safety. Safety includes a range of hazards including mishaps, injuries on the job, and patient care hazards. The most common safety mishaps are \"needle-sticks\" (staff accidentally stick themselves with a needle) or patient injury during care. As a manager, ensure all staff and patients are safe within the facility. Note: it\u2019s everyone\u2019s responsibility!\nThere are several meetings that medical equipment managers are required to attend as the organizations technical representative:\n\nPatient Safety\nEnvironment of Care\nSpace Utilization Committee\nEquipment Review Board\nInfection Control (optional)\nEducational Requirements For Bio-Medical Engineer :\nStudents should take the most challenging science, math, and English courses available in high school. \nAll biomedical engineers have at least a bachelor's degree in engineering. Many have advanced graduate degrees as well. Courses of study include a sound background in mechanical, chemical, or industrial engineering, and specialized biomedical training. Most programs last from four to six years, and all states require biomedical engineers to pass examinations and be licensed.\nDuties & Responsibilities For Bio-Medical Engineer:\nDescription:\nBiomedical Engineers use engineering principles to solve health related and medical problems. They do a lot of research in conjunction with life scientists, chemists, and medical professionals to design medical devices like artificial hearts, pacemakers, dialysis machines, and surgical lasers. Some conduct research on biological and other life systems or investigate ways to modernize laboratory and clinical procedures. \nFrequently, biomedical engineers supervise biomedical equipment maintenance technicians, investigate medical equipment failure, and advise hospitals about purchasing and installing new equipment. \nBiomedical engineers work in hospitals, universities, industry, and research laboratories.\n\n<\/p>Working Conditions : \nBiomedical engineers work in offices, laboratories, workshops, manufacturing plants, clinics and hospitals. Some local travel may be required if medical equipment is located in various clinics or hospitals. \nMost biomedical engineers work standard weekday hours. Longer hours may be required to meet research deadlines, work with patients at times convenient to them, or work on medical equipment that is in use during daytime hours.\n\n<\/p>Duties : \nBiomedical engineers work closely with life scientists, chemists and medical professionals (physicians, nurses, therapists and technicians) on the engineering aspects of biological systems. \nDuties and responsibilities vary from one position to another but, in general, biomedical engineers:\n\n<\/p>\u2022\tdesign and develop medical devices such as artificial hearts and kidneys, pacemakers, artificial hips, surgical lasers, automated patient monitors and blood chemistry sensors.\n\u2022\tdesign and develop engineered therapies (for example, neural-integrative prostheses).\n\u2022\tadapt computer hardware or software for medical science or health care applications (for example, develop expert systems that assist in diagnosing diseases, medical imaging systems, models of different aspects of human physiology or medical data management).\n\u2022\tconduct research to test and modify known theories and develop new theories.\n\u2022\tensure the safety of equipment used for diagnosis, treatment and monitoring.\n\u2022\tinvestigate medical equipment failures and provide advice about the purchase and installation of new equipment.\n\u2022\tdevelop and evaluate quantitative models of biological processes and systems.\n\u2022\tapply engineering methods to answer basic questions about how the body works.\n\u2022\tcontribute to patient assessments.\n\u2022\tprepare and present reports for health professionals and the public.\n\u2022\tsupervise and train technologists and technicians.\nBiomedical engineers may work primarily in one or a combination of the following fields:\n\u2022\tbioinformatics \u2013 developing and using computer tools to collect and analyze data.\n\u2022\tbioinstrumentation \u2013 applying electronic and measurement techniques.\n\u2022\tbiomaterials \u2013 developing durable materials that are compatible with a biological environment.\n\u2022\tbiomechanics - applying knowledge of mechanics to biological or medical problems.\n\u2022\tbio-nano-engineering \u2013 developing novel structures of nanometer dimensions for application to biology, drug delivery, molecular diagnostics, microsystems and nanosystems.\n\u2022\tbiophotonics \u2013 applying and manipulating light, usually laser light, for sensing or imaging properties of biological tissue.\n\u2022\tcellular and tissue engineering \u2013 studying the anatomy, biochemistry and mechanics of cellular and sub-cellular structures, developing technology to repair, replace or regenerate living tissues and developing methods for controlling cell and tissue growth in the laboratory.\n\u2022\tclinical engineering \u2013 applying the latest technology to health care and health care systems in hospitals.\n\u2022\tgenomics and genetic engineering \u2013 mapping, sequencing and analyzing genomes (DNA), and applying molecular biology methods to manipulate the genetic material of cells, viruses and organisms.\n\u2022\tmedical or biological imaging \u2013 combining knowledge of a physical phenomenon (for example, sound, radiation or magnetism) with electronic processing, analysis and display.\n\u2022\tmolecular bioengineering \u2013 designing molecules for biomedical purposes and applying computational methods for simulating biomolecular interactions.\n\u2022\tsystems physiology - studying how systems function in living organisms.\n\u2022\ttherapeutic engineering \u2013 developing and discovering drugs and advanced materials and techniques for delivering drugs to local tissues with minimized side effects.\nThe National Institute for Occupational Safety and Health (NIOSH) developed the Occupational Health Safety Network (OHSN) to help hospitals manage their occupational safety and health data. OHSN, a secure electronic surveillance system, allows hospitals and other healthcare facilities to upload the occupational injury data they already collect to the secure database for analysis and benchmarking with other de-identified facilities. NIOSH works with OHSN participants in identifying and implementing timely and targeted interventions. OHSN modules currently focus on three high risk and preventable events that can lead to injuries or musculoskeletal disorders among healthcare personnel: musculoskeletal injuries from patient handling activities; slips, trips, and falls; and workplace violence. OHSN can be used to meet regulatory and accreditation requirements of OSHA and The Joint Commission. OHSN enrollment is open to all healthcare facilities.\n\nReferences \nBowles, Roger \"Techcareers: Biomedical Equipment Technicians\" TSTC Publishing\nDyro, Joseph., Clinical Engineering Handbook (Biomedical Engineering).\nKhandpur, R. S. \"Biomedical Instrumentation: Technology and Applications\". McGraw Hills\nNorthrop, Robert B., \"Noninvasive Instrumentation and Measurement in Medical Diagnosis (Biomedical Engineering)\".\nWebb, Andrew G., \"Introduction to Biomedical Imaging (IEEE Press Series on Biomedical Engineering)\".\nYadin David, Wolf W. von Maltzahn, Michael R. Neuman, and Joseph D. Bronzino,. Clinical Engineering (Principles and Applications in Engineering).\nVillafa\u00f1e, Carlos CBET: \"Biomed: From the Student's Perspective\" (ISBN 978-1-61539-663-4). www.Biomedtechnicians.com.\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_equipment_management\">https:\/\/www.limswiki.org\/index.php\/Medical_equipment_management<\/a>\n\t\t\t\t\tCategories: Healthcare termsMedical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 12 March 2016, at 16:38.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 441 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","94d576c5d095ff5b727c95343fde5efa_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Medical_equipment_management skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Medical equipment management<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Healthcare Technology Management<\/b> (sometimes referred to as clinical engineering, clinical engineering management, clinical technology management, healthcare technology management, medical equipment management, biomedical maintenance, biomedical equipment management, and biomedical engineering) is a term for the professionals who manage operations, analyze and improve utilization and safety, and support servicing healthcare technology. These healthcare technology managers are, much like other healthcare professionals referred to by various specialty or organizational hierarchy names.\n<\/p><p>Some of the titles of healthcare technology management professionals are biomed, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical_Equipment_Technician\" class=\"mw-redirect\" title=\"Biomedical Equipment Technician\" rel=\"external_link\" target=\"_blank\">biomedical equipment technician<\/a>, biomedical engineering technician, biomedical engineer, BMET, biomedical equipment management, biomedical equipment services, imaging service engineer, imaging specialist, clinical engineer technician, clinical engineering equipment technician, field service engineer, field clinical engineer, clinical engineer, and medical equipment repair person. Regardless of the various titles, these professionals offer services within and outside of healthcare settings to enhance the safety, utilization, and performance on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical devices<\/a>, applications, and systems.\n<\/p><p>They are a fundamental part of managing, maintaining, and\/or designing medical devices, applications, and systems for use in various <a href=\"https:\/\/en.wikipedia.org\/wiki\/Healthcare\" class=\"mw-redirect\" title=\"Healthcare\" rel=\"external_link\" target=\"_blank\">healthcare<\/a> settings, from the home and the field to the doctor's office and the hospital.\n<\/p><p>HTM includes the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Business_process\" title=\"Business process\" rel=\"external_link\" target=\"_blank\">business processes<\/a> used in interaction and oversight of the technology involved in the diagnosis, treatment, and monitoring of patients. The related policies and procedures govern activities such as the selection, planning, and acquisition of medical devices, and the inspection, acceptance, maintenance, and eventual retirement and disposal of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_equipment\" title=\"Medical equipment\" rel=\"external_link\" target=\"_blank\">medical equipment<\/a>. \n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Responsibilities_of_the_Healthcare_Technology_Management_Professional\">Responsibilities of the Healthcare Technology Management Professional<\/span><\/h2>\n<p>The healthcare technology management professional's purpose is to ensure that equipment and systems used in patient care are operational, safe, and properly configured to meet the mission of the healthcare; that the equipment is used in an effective way consistent with the highest standards of care by educating the healthcare provider, equipment user, and patient; that the equipment is designed to limit the potential for loss, harm, or damage to the patient, provider, visitor, and facilities through various means of analysis prior to and during acquisition, monitoring and foreseeing problems during the lifecycle of the equipment, and collaborating with the parties who manufacture, design, regulate, or recommend safe medical devices and systems.\n<\/p><p>Some but not all of the healthcare technology management professional's functions are:\n<\/p>\n<ul><li>Equipment Control & <a href=\"https:\/\/en.wikipedia.org\/wiki\/Asset_management\" title=\"Asset management\" rel=\"external_link\" target=\"_blank\">Asset Management<\/a><\/li>\n<li>Equipment Inventories<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Work_order\" title=\"Work order\" rel=\"external_link\" target=\"_blank\">Work Order<\/a> Management<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Data_quality\" title=\"Data quality\" rel=\"external_link\" target=\"_blank\">Data Quality<\/a> Management<\/li>\n<li>Equipment Maintenance Management<\/li>\n<li>Equipment Maintenance<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Personnel_management\" class=\"mw-redirect\" title=\"Personnel management\" rel=\"external_link\" target=\"_blank\">Personnel Management<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Quality_assurance\" title=\"Quality assurance\" rel=\"external_link\" target=\"_blank\">Quality Assurance<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_safety\" title=\"Patient safety\" rel=\"external_link\" target=\"_blank\">Patient Safety<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Risk_management\" title=\"Risk management\" rel=\"external_link\" target=\"_blank\">Risk Management<\/a><\/li>\n<li>Hospital Safety Programs<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiation_safety\" class=\"mw-redirect\" title=\"Radiation safety\" rel=\"external_link\" target=\"_blank\">Radiation Safety<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_gas_supply\" title=\"Medical gas supply\" rel=\"external_link\" target=\"_blank\">Medical Gas<\/a> Systems<\/li>\n<li>In-Service Education & Training<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Accident_investigation\" class=\"mw-redirect\" title=\"Accident investigation\" rel=\"external_link\" target=\"_blank\">Accident Investigation<\/a><\/li>\n<li>Analysis of Failures, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Root_cause_analysis\" title=\"Root cause analysis\" rel=\"external_link\" target=\"_blank\">Root Causes<\/a>, and Human Factors<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Safe_Medical_Device_Amendments_of_1990\" title=\"Safe Medical Device Amendments of 1990\" rel=\"external_link\" target=\"_blank\">Safe Medical Devices Act (SMDA) of 1990<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_Insurance_Portability_and_Accountability_Act\" title=\"Health Insurance Portability and Accountability Act\" rel=\"external_link\" target=\"_blank\">Health Insurance Portability and Accountability Act<\/a> (HIPAA)<\/li>\n<li>Careers in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Facility_management\" title=\"Facility management\" rel=\"external_link\" target=\"_blank\">Facilities Management<\/a><\/li><\/ul>\n<h2><span id=\"rdp-ebb-Equipment_Control_.26_Asset_Management\"><\/span><span class=\"mw-headline\" id=\"Equipment_Control_&_Asset_Management\">Equipment Control & Asset Management<\/span><\/h2>\n<p>Every <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_facility\" title=\"Health facility\" rel=\"external_link\" target=\"_blank\">medical treatment facility<\/a> should have policies and processes on equipment control and asset management. Equipment control and asset management involves the management of medical devices within a facility and may be supported by automated information systems (e.g., <a href=\"https:\/\/en.wikipedia.org\/wiki\/Enterprise_resource_planning\" title=\"Enterprise resource planning\" rel=\"external_link\" target=\"_blank\">enterprise resource planning<\/a> (ERP) systems are often found in U.S. hospitals, and the U.S. military health system uses an advanced automated system known as the Defense Medical Logistics Standard Support (DMLSS) suite of applications) or may use a dedicated equipment management and maintenance software (e.g., <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.bmeassistor.in\" target=\"_blank\">BME Assistor<\/a>). Equipment control begins with the receipt of a newly acquired equipment item and continues through the item's entire lifecycle. Newly acquired devices should be inspected by in-house or contracted biomedical equipment technicians (BMETs), who will receive an established equipment control\/asset number from the facilities equipment\/property manager. This control number is used to track and record maintenance actions in their database. This is similar to creating a new chart for a new patient who will be seen at the medical facility. Once an equipment control number is established, the device is safety inspected and readied for delivery to clinical and treatment areas in the facility. \n<\/p><p>Facilities or healthcare delivery networks may rely on a combination of equipment service providers such as manufacturers, third-party services, in-house technicians, and remote support. Equipment managers are responsible for continuous oversight and responsibility for ensuring safe and effective equipment performance through full-service maintenance. Medical equipment managers are also responsible for technology assessment, planning and management in all areas within a medical treatment facility (e.g. developing policies and procedures for the medical equipment management plan, identifying trends and the need for staff education, resolution of defective biomedical equipment issues).\n<\/p><p>This industry is new, and there is not a clear line between IT and Bio-Med.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Work_Order_Management\">Work Order Management<\/span><\/h2>\n<p>Work order management involves systematic, measurable, and traceable methods to all acceptance\/initial inspections, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Preventive_maintenance\" title=\"Preventive maintenance\" rel=\"external_link\" target=\"_blank\">preventive maintenance<\/a>, and calibrations, or repairs by generating scheduled and unscheduled work orders. Work order management may be paper-based or computer-base and includes the maintenance of active (open or uncompleted) and completed work orders which provide a comprehensive maintenance history of all medical equipment devices used in the diagnosis, treatment, and management of patients. Work order management includes all safety, preventive, calibration, test, and repair services performed on all such medical devices. A comprehensive work order management system can also be used as a resource and workload management tool by managers responsible for personnel time, total number of hour\u2019s technician spent working on equipment, maximum repair dollar for one time repair, or total dollar allowed to spend repairing equipment versus replacement.\n<\/p><p>Post-work order quality checks involve one of two methods: 100% audit of all work orders or statistical sampling of randomly selected work orders. Randomly selected work orders should place more stringent statistical controls based on the clinical criticality of the device involved. For example, 100% of items critical to patient treatment but only 50% of ancillary items may be selected for sampling. In an ideal setting, all work orders are checked, but available resources may dictate a less comprehensive approach. Work orders must be tracked regularly and all discrepancies must be corrected. Managers are responsible to identify equipment location\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Data_Quality_Management\">Data Quality Management<\/span><\/h2>\n<p>Accurate, comprehensive data are needed in any automated medical equipment management system. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_Quality_Management_System\" class=\"mw-redirect\" title=\"Clinical Quality Management System\" rel=\"external_link\" target=\"_blank\">Data quality initiatives<\/a> can help to insure the accuracy of clinical\/biomedical engineering data. The data needed to establish basic, accurate, maintainable automated records for medical equipment management includes: nomenclature, manufacturer, nameplate model, serial number, acquisition cost, condition code, and maintenance assessment. Other useful data could include: warranty, location, other contractor agencies, scheduled maintenance due dates, and intervals. These fields are vital to ensure appropriate maintenance is performed, equipment is accounted for, and devices are safe for use in patient care.\n<\/p>\n<ul><li>Nomenclature: It defines what the device is, how, and the type of maintenance is to be performed. Common nomenclature systems are taken directly from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ECRI_Institute\" title=\"ECRI Institute\" rel=\"external_link\" target=\"_blank\">ECRI Institute<\/a> Universal Medical Device Nomenclature System.<\/li>\n<li>Manufacturer: This is the name of the company that received approval from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/FDA\" class=\"mw-redirect\" title=\"FDA\" rel=\"external_link\" target=\"_blank\">FDA<\/a> to sell the device, also known as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Original_equipment_manufacturer\" title=\"Original equipment manufacturer\" rel=\"external_link\" target=\"_blank\">Original Equipment Manufacturer<\/a> (OEM).<\/li>\n<li>Nameplate model: The model number is typically located on the front\/behind of the equipment or on the cover of the service manual and is provided by the OEM. E.g. Medtronic PhysioControl\u2019s Lifepak 10 Defibrillator can actually be any one of the following correct model numbers listed: 10-41, 10-43, 10 -47, 10-51, and 10-57.<\/li>\n<li>Serial number: This is usually found on the data plate as well, is a serialized number (could contain alpha characters) provided by the manufacturer. This number is crucial to device alerts and recalls.<\/li>\n<li>Acquisition cost: The total purchased price for an individual item or system. This cost should include installation, shipping, and other associated costs. These numbers are crucial for budgeting, maintenance expenditures, and depreciation reporting.<\/li>\n<li>Condition code: This code is mainly used when an item is turned in and should be changed when there are major changes to the device that could affect whether or not an item should be salvaged, destroyed, or used by another Medical Treatment Facility.<\/li>\n<li>Maintenance assessment: This assessment must be validated every time a BMET performs any kind of maintenance on a device.<\/li><\/ul>\n<p>Several other management tools, such as equipment replacement planning and budgeting, depreciation calculations, and at the local level literature, repair parts, and supplies are directly related to one or more of these fundamental basics. Data Quality must be tracked monthly and all discrepancies must be corrected.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Quality_Assurance\">Quality Assurance<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Quality_Assurance\" class=\"mw-redirect\" title=\"Quality Assurance\" rel=\"external_link\" target=\"_blank\">Quality Assurance<\/a> is a way of identifying an item of supply or equipment as being defective. A good quality control\/engineering program improves quality of work and lessens the risk of staff\/patient injuries\/death.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Patient_Safety\">Patient Safety<\/span><\/h2>\n<p>Safety of our patients\/staff is paramount to the success of our organizations mission. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_Commission\" title=\"Joint Commission\" rel=\"external_link\" target=\"_blank\">Joint Commission<\/a> publishes annual lists detailing \u201cNational Patient Safety Goals\u201d to be implemented by healthcare organizations. Goals are developed by experts in patient safety nurses, physicians, pharmacists, risk managers, and other professionals with patient-safety experience in a variety of settings. Patient safety is among the most important goals of every healthcare provider, and participation in a variety of committees and processes concerned with patient safety provides a way for biomedical managers and clinical engineering departments to gain visibility and positively affect their workplace.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Risk_management\">Risk management<\/span><\/h2>\n<p>This program helps the medical treatment facility avoid the likelihood of equipment-related risks, minimize liability of mishaps and incidents, and stay compliant with regulatory reporting requirements. The best practice is to use a rating system for every equipment type. For example, a risk-rating system might rate defibrillators as considered high risk, general-purpose infusion pumps as medium risk, electronic thermometers as low risk, and otoscopes as no significant risk. This system could be set up using Microsoft Excel or Access program for a manager's or technician's quick reference.\n<\/p><p>In addition, user error, equipment abuse, no problem\/fault found occurrences must be tracked to assist risk management personnel in determining whether additional clinical staff training must be performed.\n<\/p><p>Risk management for IT networks incorporating medical devices will be covered by the standard . Its purpose is: \"Recognizing that MEDICAL DEVICES are incorporated into IT-NETWORKS to achieve desirable benefits (for example, INTEROPERABILITY), this international standard defines the roles, responsibilities and activities that are necessary for RISK MANAGEMENT of IT-NETWORKS incorporating MEDICAL DEVICES to address the KEY PROPERTIES\". It resorts some basic ideas of <a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO_20000\" class=\"mw-redirect\" title=\"ISO 20000\" rel=\"external_link\" target=\"_blank\">ISO 20000<\/a> in the context of medical applications, e.g. configuration, incident, problem, change and release management, and risk analysis, control and evaluation according to <a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO_14971\" title=\"ISO 14971\" rel=\"external_link\" target=\"_blank\">ISO 14971<\/a>. IEC 80001 \"applies to RESPONSIBLE ORGANIZATIONS, MEDICAL DEVICE manufacturers and other providers of information technologies for the purpose of comprehensive RISK MANAGEMENT\".\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Hospital_Safety_Programs\">Hospital Safety Programs<\/span><\/h2>\n<p>The Joint Commission stipulates seven management plans for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital_accreditation\" title=\"Hospital accreditation\" rel=\"external_link\" target=\"_blank\">hospital accreditation<\/a>. One of the seven is safety. Safety includes a range of hazards including mishaps, injuries on the job, and patient care hazards. The most common safety mishaps are \"needle-sticks\" (staff accidentally stick themselves with a needle) or patient injury during care. As a manager, ensure all staff and patients are safe within the facility. Note: it\u2019s everyone\u2019s responsibility!\n<\/p><p>There are several meetings that medical equipment managers are required to attend as the organizations technical representative:\n<\/p>\n<ul><li>Patient Safety<\/li>\n<li>Environment of Care<\/li>\n<li>Space Utilization Committee<\/li>\n<li>Equipment Review Board<\/li>\n<li>Infection Control (optional)<\/li><\/ul>\n<p><b>Educational Requirements For Bio-Medical Engineer :<\/b>\nStudents should take the most challenging science, math, and English courses available in high school. \nAll biomedical engineers have at least a bachelor's degree in engineering. Many have advanced graduate degrees as well. Courses of study include a sound background in mechanical, chemical, or industrial engineering, and specialized biomedical training. Most programs last from four to six years, and all states require biomedical engineers to pass examinations and be licensed.\n<\/p><p><b>Duties & Responsibilities For Bio-Medical Engineer:<\/b>\n<p>Description:\nBiomedical Engineers use engineering principles to solve health related and medical problems. They do a lot of research in conjunction with life scientists, chemists, and medical professionals to design medical devices like artificial hearts, pacemakers, dialysis machines, and surgical lasers. Some conduct research on biological and other life systems or investigate ways to modernize laboratory and clinical procedures. \nFrequently, biomedical engineers supervise biomedical equipment maintenance technicians, investigate medical equipment failure, and advise hospitals about purchasing and installing new equipment. \nBiomedical engineers work in hospitals, universities, industry, and research laboratories.\n<\/p>\n<\/p><p><b>Working Conditions :<\/b> \n<p>Biomedical engineers work in offices, laboratories, workshops, manufacturing plants, clinics and hospitals. Some local travel may be required if medical equipment is located in various clinics or hospitals. \nMost biomedical engineers work standard weekday hours. Longer hours may be required to meet research deadlines, work with patients at times convenient to them, or work on medical equipment that is in use during daytime hours.\n<\/p>\n<\/p><p><b>Duties :<\/b> \n<p>Biomedical engineers work closely with life scientists, chemists and medical professionals (physicians, nurses, therapists and technicians) on the engineering aspects of biological systems. \nDuties and responsibilities vary from one position to another but, in general, biomedical engineers:\n<\/p>\n<\/p><p>\u2022\tdesign and develop medical devices such as artificial hearts and kidneys, pacemakers, artificial hips, surgical lasers, automated patient monitors and blood chemistry sensors.\n<\/p><p>\u2022\tdesign and develop engineered therapies (for example, neural-integrative prostheses).\n<\/p><p>\u2022\tadapt computer hardware or software for medical science or health care applications (for example, develop expert systems that assist in diagnosing diseases, medical imaging systems, models of different aspects of human physiology or medical data management).\n<\/p><p>\u2022\tconduct research to test and modify known theories and develop new theories.\n<\/p><p>\u2022\tensure the safety of equipment used for diagnosis, treatment and monitoring.\n<\/p><p>\u2022\tinvestigate medical equipment failures and provide advice about the purchase and installation of new equipment.\n<\/p><p>\u2022\tdevelop and evaluate quantitative models of biological processes and systems.\n<\/p><p>\u2022\tapply engineering methods to answer basic questions about how the body works.\n<\/p><p>\u2022\tcontribute to patient assessments.\n<\/p><p>\u2022\tprepare and present reports for health professionals and the public.\n<\/p><p>\u2022\tsupervise and train technologists and technicians.\n<\/p><p><b>Biomedical engineers may work primarily in one or a combination of the following fields:<\/b>\n<\/p><p>\u2022\t<b>bioinformatics<\/b> \u2013 developing and using computer tools to collect and analyze data.\n<\/p><p>\u2022\t<b>bioinstrumentation<\/b> \u2013 applying electronic and measurement techniques.\n<\/p><p>\u2022\t<b>biomaterials<\/b> \u2013 developing durable materials that are compatible with a biological environment.\n<\/p><p>\u2022\t<b>biomechanics<\/b> - applying knowledge of mechanics to biological or medical problems.\n<\/p><p>\u2022\t<b>bio-nano-engineering<\/b> \u2013 developing novel structures of nanometer dimensions for application to biology, drug delivery, molecular diagnostics, microsystems and nanosystems.\n<\/p><p>\u2022\t<b>biophotonics<\/b> \u2013 applying and manipulating light, usually laser light, for sensing or imaging properties of biological tissue.\n<\/p><p>\u2022\t<b>cellular and tissue engineering<\/b> \u2013 studying the anatomy, biochemistry and mechanics of cellular and sub-cellular structures, developing technology to repair, replace or regenerate living tissues and developing methods for controlling cell and tissue growth in the laboratory.\n<\/p><p>\u2022\t<b>clinical engineering<\/b> \u2013 applying the latest technology to health care and health care systems in hospitals.\n<\/p><p>\u2022\t<b>genomics and genetic engineering<\/b> \u2013 mapping, sequencing and analyzing genomes (DNA), and applying molecular biology methods to manipulate the genetic material of cells, viruses and organisms.\n<\/p><p>\u2022\t<b>medical or biological imaging<\/b> \u2013 combining knowledge of a physical phenomenon (for example, sound, radiation or magnetism) with electronic processing, analysis and display.\n<\/p><p>\u2022\t<b>molecular bioengineering<\/b> \u2013 designing molecules for biomedical purposes and applying computational methods for simulating biomolecular interactions.\n<\/p><p>\u2022\t<b>systems physiology<\/b> - studying how systems function in living organisms.\n<\/p><p>\u2022\t<b>therapeutic engineering<\/b> \u2013 developing and discovering drugs and advanced materials and techniques for delivering drugs to local tissues with minimized side effects.\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Institute_for_Occupational_Safety_and_Health\" title=\"National Institute for Occupational Safety and Health\" rel=\"external_link\" target=\"_blank\">National Institute for Occupational Safety and Health (NIOSH)<\/a> developed the <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/niosh\/topics\/ohsn\/\" target=\"_blank\">Occupational Health Safety Network (OHSN)<\/a> to help hospitals manage their occupational safety and health data. OHSN, a secure electronic surveillance system, allows hospitals and other healthcare facilities to upload the occupational injury data they already collect to the secure database for analysis and benchmarking with other de-identified facilities. NIOSH works with OHSN participants in identifying and implementing timely and targeted interventions. OHSN modules currently focus on three high risk and preventable events that can lead to injuries or musculoskeletal disorders among healthcare personnel: musculoskeletal injuries from patient handling activities; slips, trips, and falls; and workplace violence. OHSN can be used to meet regulatory and accreditation requirements of OSHA and The Joint Commission. OHSN enrollment is open to all healthcare facilities.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<ul><li>Bowles, Roger \"Techcareers: Biomedical Equipment Technicians\" TSTC Publishing<\/li>\n<li>Dyro, Joseph., Clinical Engineering Handbook (Biomedical Engineering).<\/li>\n<li>Khandpur, R. S. \"Biomedical Instrumentation: Technology and Applications\". McGraw Hills<\/li>\n<li>Northrop, Robert B., \"Noninvasive Instrumentation and Measurement in Medical Diagnosis (Biomedical Engineering)\".<\/li>\n<li>Webb, Andrew G., \"Introduction to Biomedical Imaging (IEEE Press Series on Biomedical Engineering)\".<\/li>\n<li>Yadin David, Wolf W. von Maltzahn, Michael R. Neuman, and Joseph D. Bronzino,. Clinical Engineering (Principles and Applications in Engineering).<\/li>\n<li>Villafa\u00f1e, Carlos CBET: \"Biomed: From the Student's Perspective\" (<a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-61539-663-4). www.Biomedtechnicians.com.<\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1255\nCached time: 20181217101851\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.176 seconds\nReal time usage: 0.257 seconds\nPreprocessor visited node count: 723\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 28023\/2097152 bytes\nTemplate argument size: 8022\/2097152 bytes\nHighest expansion depth: 19\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 1549\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.044\/10.000 seconds\nLua memory usage: 1.56 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 211.453 1 -total\n<\/p>\n<pre>88.58% 187.311 3 Template:Ambox\n70.60% 149.278 1 Template:Multiple_issues\n36.54% 77.256 1 Template:Cleanup\n29.27% 61.887 1 Template:ISBN\n19.32% 40.846 1 Template:Catalog_lookup_link\n17.18% 36.318 4 Template:Main_other\n14.81% 31.310 1 Template:Category_handler\n 9.98% 21.094 1 Template:No_footnotes\n 9.13% 19.316 1 Template:DMC\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:14621467-1!canonical and timestamp 20181217101851 and revision id 848540836\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_equipment_management\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214711\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.148 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 142.377 1 - wikipedia:Medical_equipment_management\n100.00% 142.377 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8450-0!*!*!*!*!*!* and timestamp 20181217214711 and revision id 24699\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Medical_equipment_management\">https:\/\/www.limswiki.org\/index.php\/Medical_equipment_management<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","94d576c5d095ff5b727c95343fde5efa_images":[],"94d576c5d095ff5b727c95343fde5efa_timestamp":1545083231,"f3e83632cf521f2169bcf4025f12dafe_type":"article","f3e83632cf521f2169bcf4025f12dafe_title":"Implant failure","f3e83632cf521f2169bcf4025f12dafe_url":"https:\/\/www.limswiki.org\/index.php\/Implant_failure","f3e83632cf521f2169bcf4025f12dafe_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tImplant failure\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tImplant failure refers to the failure of any medical implant to meet the claims of its manufacturer or the health care provider which installs it. Implant failure can have any number of causes. The rates of failure vary for different implants.\nThe monitoring of the safety of implants is conducted within the context of broader pharmacovigilance.\n\nContents \n\n1 Common types of failure \n\n1.1 Material degradation \n1.2 Bacterial infection \n1.3 Hip replacement failure \n1.4 Pacemaker failure \n1.5 Cochlear implant failure \n1.6 Dental implant failure \n\n\n2 Responses to implant failure \n3 References \n4 Further reading \n5 External links \n\n\nCommon types of failure \nMaterial degradation \nImplant failure can occur due to the degradation of the material an implant is made of. With time, mechanical degradation, in the form of wear or fatigue, or electrochemical degradation, in the form of corrosion, can occur. Biotoxicity, particularly in metal implants, can arise due to ion release.\n\nBacterial infection \nImplants, made of synthetic materials, are naturally coated by a biofilm by the body, which may function as a favorable medium for bacteria growth.\nImplant failure due to bacterial infection of the implant can occur at any point of implant lifetime. Bacteria may already reside on the implant or be introduced during the implantation.\nTypical failure mechanisms include tissue damage and implant detachment due to bacteria generated biofilm.\n\nHip replacement failure \nHip replacement implants can fail. Outcomes are normally recorded in a joint replacement registry to ensure patterns are picked-up upon.\nIn 2013 Johnson & Johnson shared documents which indicated that 40% of a class of hip replacement implants which it manufactured had failed.[1]\n\nPacemaker failure \nMain article: Pacemaker failure\nPacemaker failure is the inability of an implanted artificial pacemaker to perform its intended function of regulating the beating of the heart. It is defined by the requirement of repeat surgical pacemaker-related procedure after the initial implantation. Causes of pacemaker failure included: lead related failure (lead migration, lead fracture, ventricular perforation), unit malfunction (battery failure or component malfunction), problems at the insertion site (infections, tissue breakdown, battery pack migration), and failures related to exposure to high voltage electricity or high intensity microwaves.[citation needed ]\n\nCochlear implant failure \nCochlear implants are used to treat severe to profound hearing loss by electrically stimulating the hearing nerve. Clinical symptoms of cochlear implant failure include auditory symptoms (tinnitus, buzzing, roaring, popping sounds), non-auditory symptoms (pain, shocking sensation, burning sensation, facial stimulation, itching), and decrease in the patient's hearing performance.[2] When such symptoms occur, the patient's clinical team evaluates the patient and the device using in-situ methods, and determines if revision surgery is necessary. The most commonly reported device failures are due to impacts, loss of hermeticity, and electrode lead malfunctions. Most manufacturers provide on their websites the survival rate of their marketed implants, although they are not required to do so. In order to improve and standardize failure reporting practices to the public, the AAMI is developing an American standard for cochlear implants in collaboration with the FDA, major cochlear implant manufacturers, the CALCE center for reliability, doctors, and clinicians.[3]\n\nDental implant failure \nMain article: Dental implant failure\nFailure of a dental implant is often related to the failure of the implant to osseointegrate correctly with the bone, or vice versa.[citation needed ] A dental implant is considered to be a failure if it is lost, mobile or shows peri-implant (around the implant) bone loss of greater than 1.0 mm in the first year and greater than 0.2 mm a year after.[4]\nDental implant failures have been studied.[5] Persons who smoke habitually prior to having dental implants are significantly more likely to have their implants fail.[6]\n\nResponses to implant failure \nIn 2012 Royal College of Surgeons of England and the British Orthopaedic Association called for increased regulation of implants to prevent implant failure.[7]\nA 2011 study by Dr. Diana Zuckerman and Paul Brown of the National Research Center for Women and Families, and Dr. Steven Nissen of the Cleveland Clinic, published in the Archives of Internal Medicine, showed that most medical devices recalled in the last five years for \u201cserious health problems or death\u201d had been previously approved by the FDA using the less stringent, and cheaper, 510(k) process. In a few cases the devices had been deemed so low-risk that they did not need FDA regulation. Of the 113 devices recalled, 35 were for cardiovacular issues.[8] This may lead to a reevaluation of FDA procedures and better oversight.\n\nReferences \n\n\n^ Meier, Barry (22 January 2013). \"Maker Aware of 40% Failure in Hip Implant - NYTimes.com\". The New York Times. New York: NYTC. ISSN 0362-4331. Retrieved 5 June 2013 . \n\n^ Balkany TJ; Hodges AV; Buchman CA; Luxford WM; Pillsbury CH; Roland PS; Shallop JK; Backous DD; Franz D; Graham JM; Hirsch B; Luntz M; Niparko JK; Patrick J; Payne SL; Telischi FF; Tobey EA; Truy E; Staller S (2005). \"Cochlear implant soft failures consensus development conference statement\". Otol. Neurotol. 26: 815\u20138. PMID 16015190. \n\n^ https:\/\/standards.aami.org\/kws\/public\/workgroup?wg_abbrev=CI \n\n^ Template:Tissue-integrated prostheses :osseointegration in clinical dentistry, Per-Ingavar Branemark, George A. Zarb, Tomas Albrektsson, 1985 \n\n^ Moy, P. K.; Medina, D.; Shetty, V.; Aghaloo, T. L. (2005). \"Dental implant failure rates and associated risk factors\". The International journal of oral & maxillofacial implants. 20 (4): 569\u2013577. PMID 16161741. \n\n^ De Bruyn, H.; Collaert, B. (1994). \"The effect of smoking on early implant failure\". Clinical Oral Implants Research. 5 (4): 260\u2013264. doi:10.1034\/j.1600-0501.1994.050410.x. PMID 7640341. \n\n^ Watt, Holly; Newell, Claire (24 Oct 2012). \"Faulty medical implants investigation: Patients failed by poor implant regulation, say surgeons - Telegraph\". The Daily Telegraph. London: TMG. ISSN 0307-1235. OCLC 49632006. Retrieved 5 June 2013 . \n\n^ Zuckerman, Diana (2011). \"Medical Device Recalls and the FDA Approval Process\". Archives of Internal Medicine. 171: 1006\u201311. doi:10.1001\/archinternmed.2011.30. PMID 21321283. \n\n\nFurther reading \nGroeger, Lisa (30 April 2012). \"Four Medical Implants That Escaped FDA Scrutiny - ProPublica\". propublica.org. Retrieved 5 June 2013 . \nWagenberg, B.; Froum, S. J. (2006). \"A retrospective study of 1925 consecutively placed immediate implants from 1988 to 2004\". The International journal of oral & maxillofacial implants. 21 (1): 71\u201380. PMID 16519184. \nDe Bruyn, H.; Collaert, B. (1994). \"The effect of smoking on early implant failure\". Clinical Oral Implants Research. 5 (4): 260\u2013264. doi:10.1034\/j.1600-0501.1994.050410.x. PMID 7640341. \nTang, L.; Eaton, J. W. (1995). \"Inflammatory responses to biomaterials\". American journal of clinical pathology. 103 (4): 466\u2013471. doi:10.1093\/ajcp\/103.4.466. PMID 7726145. \nPapageorgiou, S. N.; Zogakis, I. P.; Papadopoulos, M. A. (2012). \"Failure rates and associated risk factors of orthodontic miniscrew implants: A meta-analysis\". American Journal of Orthodontics and Dentofacial Orthopedics. 142 (5): 577\u2013595.e7. doi:10.1016\/j.ajodo.2012.05.016. PMID 23116500. \nExternal links \n2011 United States government report on implant safety\nFailed Implant Device Alliance, a grassroots organization advocating for implant safety\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Implant_failure\">https:\/\/www.limswiki.org\/index.php\/Implant_failure<\/a>\n\t\t\t\t\tCategories: Healthcare termsImplant-related medical conditionsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 17:58.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 633 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","f3e83632cf521f2169bcf4025f12dafe_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Implant_failure skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Implant failure<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Implant failure<\/b> refers to the failure of any <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">medical implant<\/a> to meet the claims of its manufacturer or the health care provider which installs it. Implant failure can have any number of causes. The rates of failure vary for different implants.\n<\/p><p>The monitoring of the safety of implants is conducted within the context of broader <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacovigilance\" title=\"Pharmacovigilance\" rel=\"external_link\" target=\"_blank\">pharmacovigilance<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Common_types_of_failure\">Common types of failure<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Material_degradation\">Material degradation<\/span><\/h3>\n<p>Implant failure can occur due to the degradation of the material an implant is made of. With time, mechanical degradation, in the form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wear\" title=\"Wear\" rel=\"external_link\" target=\"_blank\">wear<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fatigue_(material)\" title=\"Fatigue (material)\" rel=\"external_link\" target=\"_blank\">fatigue<\/a>, or electrochemical degradation, in the form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corrosion\" title=\"Corrosion\" rel=\"external_link\" target=\"_blank\">corrosion<\/a>, can occur. , particularly in metal implants, can arise due to ion release.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Bacterial_infection\">Bacterial infection<\/span><\/h3>\n<p>Implants, made of synthetic materials, are naturally coated by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biofilm\" title=\"Biofilm\" rel=\"external_link\" target=\"_blank\">biofilm<\/a> by the body, which may function as a favorable medium for bacteria growth.\nImplant failure due to bacterial infection of the implant can occur at any point of implant lifetime. Bacteria may already reside on the implant or be introduced during the implantation.\nTypical failure mechanisms include tissue damage and implant detachment due to bacteria generated biofilm.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hip_replacement_failure\">Hip replacement failure<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">Hip replacement<\/a> implants can fail. Outcomes are normally recorded in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement_registry\" title=\"Joint replacement registry\" rel=\"external_link\" target=\"_blank\">joint replacement registry<\/a> to ensure patterns are picked-up upon.\n<\/p><p>In 2013 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Johnson_%26_Johnson\" title=\"Johnson & Johnson\" rel=\"external_link\" target=\"_blank\">Johnson & Johnson<\/a> shared documents which indicated that 40% of a class of hip replacement implants which it manufactured had failed.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Pacemaker_failure\">Pacemaker failure<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pacemaker_failure\" title=\"Pacemaker failure\" rel=\"external_link\" target=\"_blank\">Pacemaker failure<\/a><\/div>\n<p>Pacemaker failure is the inability of an implanted artificial pacemaker to perform its intended function of regulating the beating of the heart. It is defined by the requirement of repeat surgical pacemaker-related procedure after the initial implantation. Causes of pacemaker failure included: lead related failure (lead migration, lead fracture, ventricular perforation), unit malfunction (battery failure or component malfunction), problems at the insertion site (infections, tissue breakdown, battery pack migration), and failures related to exposure to high voltage electricity or high intensity microwaves.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Cochlear_implant_failure\">Cochlear implant failure<\/span><\/h3>\n<p>Cochlear implants are used to treat severe to profound hearing loss by electrically stimulating the hearing nerve. Clinical symptoms of cochlear implant failure include auditory symptoms (tinnitus, buzzing, roaring, popping sounds), non-auditory symptoms (pain, shocking sensation, burning sensation, facial stimulation, itching), and decrease in the patient's hearing performance.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> When such symptoms occur, the patient's clinical team evaluates the patient and the device using in-situ methods, and determines if revision surgery is necessary. The most commonly reported device failures are due to impacts, loss of hermeticity, and electrode lead malfunctions. Most manufacturers provide on their websites the survival rate of their marketed implants, although they are not required to do so. In order to improve and standardize failure reporting practices to the public, the AAMI is developing an American standard for cochlear implants in collaboration with the FDA, major cochlear implant manufacturers, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Center_for_Advanced_Life_Cycle_Engineering\" title=\"Center for Advanced Life Cycle Engineering\" rel=\"external_link\" target=\"_blank\">CALCE<\/a> center for reliability, doctors, and clinicians.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Dental_implant_failure\">Dental implant failure<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant_failure\" class=\"mw-redirect\" title=\"Dental implant failure\" rel=\"external_link\" target=\"_blank\">Dental implant failure<\/a><\/div>\n<p>Failure of a dental implant is often related to the failure of the implant to osseointegrate correctly with the bone, or vice versa.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2013)\">citation needed<\/span><\/a><\/i>]<\/sup> A dental implant is considered to be a failure if it is lost, mobile or shows peri-implant (around the implant) bone loss of greater than 1.0 mm in the first year and greater than 0.2 mm a year after.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>Dental implant failures have been studied.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Persons who <a href=\"https:\/\/en.wikipedia.org\/wiki\/Smoking\" title=\"Smoking\" rel=\"external_link\" target=\"_blank\">smoke<\/a> habitually prior to having dental implants are significantly more likely to have their implants fail.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Responses_to_implant_failure\">Responses to implant failure<\/span><\/h2>\n<p>In 2012 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Royal_College_of_Surgeons_of_England\" title=\"Royal College of Surgeons of England\" rel=\"external_link\" target=\"_blank\">Royal College of Surgeons of England<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/British_Orthopaedic_Association\" title=\"British Orthopaedic Association\" rel=\"external_link\" target=\"_blank\">British Orthopaedic Association<\/a> called for increased regulation of implants to prevent implant failure.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>A 2011 study by Dr. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diana_Zuckerman\" title=\"Diana Zuckerman\" rel=\"external_link\" target=\"_blank\">Diana Zuckerman<\/a> and Paul Brown of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Research_Center_for_Women_and_Families\" class=\"mw-redirect\" title=\"National Research Center for Women and Families\" rel=\"external_link\" target=\"_blank\">National Research Center for Women and Families<\/a>, and Dr. Steven Nissen of the Cleveland Clinic, published in the Archives of Internal Medicine, showed that most medical devices recalled in the last five years for \u201cserious health problems or death\u201d had been previously approved by the FDA using the less stringent, and cheaper, 510(k) process. In a few cases the devices had been deemed so low-risk that they did not need FDA regulation. Of the 113 devices recalled, 35 were for cardiovacular issues.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> This may lead to a reevaluation of FDA procedures and better oversight.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Meier, Barry (22 January 2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2013\/01\/23\/business\/jj-study-suggested-hip-device-could-fail-in-thousands-more.html?_r=0\" target=\"_blank\">\"Maker Aware of 40% Failure in Hip Implant - NYTimes.com\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_New_York_Times\" title=\"The New York Times\" rel=\"external_link\" target=\"_blank\">The New York Times<\/a><\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_York,_NY\" class=\"mw-redirect\" title=\"New York, NY\" rel=\"external_link\" target=\"_blank\">New York<\/a>: <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_York_Times_Company\" class=\"mw-redirect\" title=\"New York Times Company\" rel=\"external_link\" target=\"_blank\">NYTC<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0362-4331\" target=\"_blank\">0362-4331<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 June<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Maker+Aware+of+40%25+Failure+in+Hip+Implant+-+NYTimes.com&rft.date=2013-01-22&rft.issn=0362-4331&rft.aulast=Meier&rft.aufirst=Barry&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2013%2F01%2F23%2Fbusiness%2Fjj-study-suggested-hip-device-could-fail-in-thousands-more.html%3F_r%3D0&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Balkany TJ; Hodges AV; Buchman CA; Luxford WM; Pillsbury CH; Roland PS; Shallop JK; Backous DD; Franz D; Graham JM; Hirsch B; Luntz M; <a href=\"https:\/\/en.wikipedia.org\/wiki\/John_Niparko\" title=\"John Niparko\" rel=\"external_link\" target=\"_blank\">Niparko JK<\/a>; Patrick J; Payne SL; Telischi FF; Tobey EA; Truy E; Staller S (2005). \"Cochlear implant soft failures consensus development conference statement\". <i>Otol. Neurotol<\/i>. <b>26<\/b>: 815\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16015190\" target=\"_blank\">16015190<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Otol.+Neurotol.&rft.atitle=Cochlear+implant+soft+failures+consensus+development+conference+statement&rft.volume=26&rft.pages=815-8&rft.date=2005&rft_id=info%3Apmid%2F16015190&rft.au=Balkany+TJ&rft.au=Hodges+AV&rft.au=Buchman+CA&rft.au=Luxford+WM&rft.au=Pillsbury+CH&rft.au=Roland+PS&rft.au=Shallop+JK&rft.au=Backous+DD&rft.au=Franz+D&rft.au=Graham+JM&rft.au=Hirsch+B&rft.au=Luntz+M&rft.au=Niparko+JK&rft.au=Patrick+J&rft.au=Payne+SL&rft.au=Telischi+FF&rft.au=Tobey+EA&rft.au=Truy+E&rft.au=Staller+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"https:\/\/standards.aami.org\/kws\/public\/workgroup?wg_abbrev=CI\" target=\"_blank\">https:\/\/standards.aami.org\/kws\/public\/workgroup?wg_abbrev=CI<\/a><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Moy, P. K.; Medina, D.; Shetty, V.; Aghaloo, T. L. (2005). \"Dental implant failure rates and associated risk factors\". <i>The International journal of oral & maxillofacial implants<\/i>. <b>20<\/b> (4): 569\u2013577. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16161741\" target=\"_blank\">16161741<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+International+journal+of+oral+%26+maxillofacial+implants&rft.atitle=Dental+implant+failure+rates+and+associated+risk+factors&rft.volume=20&rft.issue=4&rft.pages=569-577&rft.date=2005&rft_id=info%3Apmid%2F16161741&rft.aulast=Moy&rft.aufirst=P.+K.&rft.au=Medina%2C+D.&rft.au=Shetty%2C+V.&rft.au=Aghaloo%2C+T.+L.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">De Bruyn, H.; Collaert, B. (1994). \"The effect of smoking on early implant failure\". <i>Clinical Oral Implants Research<\/i>. <b>5<\/b> (4): 260\u2013264. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1034%2Fj.1600-0501.1994.050410.x\" target=\"_blank\">10.1034\/j.1600-0501.1994.050410.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7640341\" target=\"_blank\">7640341<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Oral+Implants+Research&rft.atitle=The+effect+of+smoking+on+early+implant+failure&rft.volume=5&rft.issue=4&rft.pages=260-264&rft.date=1994&rft_id=info%3Adoi%2F10.1034%2Fj.1600-0501.1994.050410.x&rft_id=info%3Apmid%2F7640341&rft.aulast=De+Bruyn&rft.aufirst=H.&rft.au=Collaert%2C+B.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Watt, Holly; Newell, Claire (24 Oct 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.telegraph.co.uk\/health\/healthnews\/9631974\/Faulty-medical-implants-investigation-Patients-failed-by-poor-implant-regulation-say-surgeons.html\" target=\"_blank\">\"Faulty medical implants investigation: Patients failed by poor implant regulation, say surgeons - Telegraph\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Daily_Telegraph\" title=\"The Daily Telegraph\" rel=\"external_link\" target=\"_blank\">The Daily Telegraph<\/a><\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/London,_UK\" class=\"mw-redirect\" title=\"London, UK\" rel=\"external_link\" target=\"_blank\">London<\/a>: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telegraph_Media_Group\" title=\"Telegraph Media Group\" rel=\"external_link\" target=\"_blank\">TMG<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0307-1235\" target=\"_blank\">0307-1235<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/OCLC\" title=\"OCLC\" rel=\"external_link\" target=\"_blank\">OCLC<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/oclc\/49632006\" target=\"_blank\">49632006<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 June<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Daily+Telegraph&rft.atitle=Faulty+medical+implants+investigation%3A+Patients+failed+by+poor+implant+regulation%2C+say+surgeons+-+Telegraph&rft.date=2012-10-24&rft_id=info%3Aoclcnum%2F49632006&rft.issn=0307-1235&rft.aulast=Watt&rft.aufirst=Holly&rft.au=Newell%2C+Claire&rft_id=https%3A%2F%2Fwww.telegraph.co.uk%2Fhealth%2Fhealthnews%2F9631974%2FFaulty-medical-implants-investigation-Patients-failed-by-poor-implant-regulation-say-surgeons.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zuckerman, Diana (2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=227466\" target=\"_blank\">\"Medical Device Recalls and the FDA Approval Process\"<\/a>. <i>Archives of Internal Medicine<\/i>. <b>171<\/b>: 1006\u201311. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Farchinternmed.2011.30\" target=\"_blank\">10.1001\/archinternmed.2011.30<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21321283\" target=\"_blank\">21321283<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Internal+Medicine&rft.atitle=Medical+Device+Recalls+and+the+FDA+Approval+Process&rft.volume=171&rft.pages=1006-11&rft.date=2011&rft_id=info%3Adoi%2F10.1001%2Farchinternmed.2011.30&rft_id=info%3Apmid%2F21321283&rft.aulast=Zuckerman&rft.aufirst=Diana&rft_id=http%3A%2F%2Farchinte.jamanetwork.com%2Farticle.aspx%3Farticleid%3D227466&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation web\">Groeger, Lisa (30 April 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.propublica.org\/special\/four-medical-implants-that-escaped-fda-scrutiny\" target=\"_blank\">\"Four Medical Implants That Escaped FDA Scrutiny - ProPublica\"<\/a>. <i>propublica.org<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 June<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=propublica.org&rft.atitle=Four+Medical+Implants+That+Escaped+FDA+Scrutiny+-+ProPublica&rft.date=2012-04-30&rft.aulast=Groeger&rft.aufirst=Lisa&rft_id=https%3A%2F%2Fwww.propublica.org%2Fspecial%2Ffour-medical-implants-that-escaped-fda-scrutiny&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Wagenberg, B.; Froum, S. J. (2006). \"A retrospective study of 1925 consecutively placed immediate implants from 1988 to 2004\". <i>The International journal of oral & maxillofacial implants<\/i>. <b>21<\/b> (1): 71\u201380. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16519184\" target=\"_blank\">16519184<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+International+journal+of+oral+%26+maxillofacial+implants&rft.atitle=A+retrospective+study+of+1925+consecutively+placed+immediate+implants+from+1988+to+2004&rft.volume=21&rft.issue=1&rft.pages=71-80&rft.date=2006&rft_id=info%3Apmid%2F16519184&rft.aulast=Wagenberg&rft.aufirst=B.&rft.au=Froum%2C+S.+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">De Bruyn, H.; Collaert, B. (1994). \"The effect of smoking on early implant failure\". <i>Clinical Oral Implants Research<\/i>. <b>5<\/b> (4): 260\u2013264. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1034%2Fj.1600-0501.1994.050410.x\" target=\"_blank\">10.1034\/j.1600-0501.1994.050410.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7640341\" target=\"_blank\">7640341<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Oral+Implants+Research&rft.atitle=The+effect+of+smoking+on+early+implant+failure&rft.volume=5&rft.issue=4&rft.pages=260-264&rft.date=1994&rft_id=info%3Adoi%2F10.1034%2Fj.1600-0501.1994.050410.x&rft_id=info%3Apmid%2F7640341&rft.aulast=De+Bruyn&rft.aufirst=H.&rft.au=Collaert%2C+B.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Tang, L.; Eaton, J. W. (1995). \"Inflammatory responses to biomaterials\". <i>American journal of clinical pathology<\/i>. <b>103<\/b> (4): 466\u2013471. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Fajcp%2F103.4.466\" target=\"_blank\">10.1093\/ajcp\/103.4.466<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7726145\" target=\"_blank\">7726145<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+journal+of+clinical+pathology&rft.atitle=Inflammatory+responses+to+biomaterials&rft.volume=103&rft.issue=4&rft.pages=466-471&rft.date=1995&rft_id=info%3Adoi%2F10.1093%2Fajcp%2F103.4.466&rft_id=info%3Apmid%2F7726145&rft.aulast=Tang&rft.aufirst=L.&rft.au=Eaton%2C+J.+W.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Papageorgiou, S. N.; Zogakis, I. P.; Papadopoulos, M. A. (2012). \"Failure rates and associated risk factors of orthodontic miniscrew implants: A meta-analysis\". <i>American Journal of Orthodontics and Dentofacial Orthopedics<\/i>. <b>142<\/b> (5): 577\u2013595.e7. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ajodo.2012.05.016\" target=\"_blank\">10.1016\/j.ajodo.2012.05.016<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23116500\" target=\"_blank\">23116500<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Orthodontics+and+Dentofacial+Orthopedics&rft.atitle=Failure+rates+and+associated+risk+factors+of+orthodontic+miniscrew+implants%3A+A+meta-analysis&rft.volume=142&rft.issue=5&rft.pages=577-595.e7&rft.date=2012&rft_id=info%3Adoi%2F10.1016%2Fj.ajodo.2012.05.016&rft_id=info%3Apmid%2F23116500&rft.aulast=Papageorgiou&rft.aufirst=S.+N.&rft.au=Zogakis%2C+I.+P.&rft.au=Papadopoulos%2C+M.+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImplant+failure\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gao.gov\/products\/GAO-11-556T\" target=\"_blank\">2011 United States government report on implant safety<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/fida-advocate.blogspot.com\/\" target=\"_blank\">Failed Implant Device Alliance<\/a>, a grassroots organization advocating for implant safety<\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1275\nCached time: 20181210044315\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.252 seconds\nReal time usage: 0.337 seconds\nPreprocessor visited node count: 889\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 26531\/2097152 bytes\nTemplate argument size: 1003\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 26256\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.172\/10.000 seconds\nLua memory usage: 4.11 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 307.994 1 -total\n<\/p>\n<pre>56.95% 175.403 1 Template:Reflist\n39.65% 122.120 2 Template:Cite_news\n25.11% 77.349 2 Template:Citation_needed\n22.61% 69.638 2 Template:Fix\n15.76% 48.536 8 Template:Cite_journal\n12.24% 37.709 4 Template:Category_handler\n 8.50% 26.186 2 Template:Delink\n 8.21% 25.300 2 Template:Main\n 1.96% 6.022 1 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:39588091-1!canonical and timestamp 20181210044315 and revision id 854933411\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_failure\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214711\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.138 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 131.973 1 - wikipedia:Implant_failure\n100.00% 131.973 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8196-0!*!*!*!*!*!* and timestamp 20181217214711 and revision id 24533\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Implant_failure\">https:\/\/www.limswiki.org\/index.php\/Implant_failure<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","f3e83632cf521f2169bcf4025f12dafe_images":[],"f3e83632cf521f2169bcf4025f12dafe_timestamp":1545083231,"9a987c700a3112a55a2b8d9a6ecb9a1f_type":"article","9a987c700a3112a55a2b8d9a6ecb9a1f_title":"Gossypiboma","9a987c700a3112a55a2b8d9a6ecb9a1f_url":"https:\/\/www.limswiki.org\/index.php\/Gossypiboma","9a987c700a3112a55a2b8d9a6ecb9a1f_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tGossypiboma\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Mini-laparotomy revealed gossypiboma (grasped by the clamp).\n Surgical specimen (gossypiboma).\nGossypiboma, textiloma or more broadly Retained Foreign Object (RFO) is the technical term for a surgical complications resulting from foreign materials, such as a surgical sponge, accidentally left inside a patient's body. The term \"gossypiboma\" is derived from the Latin gossypium (\u201ccotton wool, cotton\u201d) and the suffix -oma, meaning a tumor or growth, and describes a mass within a patient's body comprising a cotton matrix surrounded by a foreign body granuloma.[1][2] \"Textiloma\" is derived from textile (surgical sponges have historically been made of cloth), and is used in place of gossypiboma due to the increasing use of synthetic materials in place of cotton.[1]\n\nContents \n\n1 Incidence and clinical presentation \n2 Prevention \n3 See also \n4 References \n5 External links \n\n\nIncidence and clinical presentation \nThe actual incidence of gossypiboma is difficult to determine, possibly due to a reluctance to report occurrences arising from fear of legal repercussions, but retained surgical sponges is reported to occur once in every 3000 to 5000 abdominal operations[2] and are most frequently discovered in the abdomen.[3] The incidence of retained foreign bodies following surgery has a reported rate of 0.01% to 0.001%, of which gossypibomas make up 80% of cases.[1]\nGossypibomas can often present, clinically or radiologically, similar to tumors and abscesses, with widely variable complications and manifestations, making diagnosis difficult and causing significant patient morbidity.[3] Two major types of reaction occur in response to retained surgical foreign bodies. In the first type, an abscess may form with or without a secondary bacterial infection. The second reaction is an aseptic fibrinous response, resulting in tissue adhesions and encapsulation and eventually foreign body granuloma.[1] Symptoms may not present for long periods of time, sometimes months or years following surgery.[1]\n\nPrevention \nTo prevent gossypiboma, sponges are counted by hand before and after surgeries. This method was codified into recommended guidelines in the 1970s by the Association of periOperative Registered Nurses (AORN).[4] Four separate counts are recommended: the first when instruments and sponges are first unpackaged and set up, a second before the beginning of the surgical procedure, a third as closure begins, and a final count during final skin closure.[5] Other guidelines have been promoted by the American College of Surgeons and the Joint Commission.[6]\nIn most countries, surgical sponges contain radiopaque material that can be readily identified in radiographic and CT images, facilitating detection.[1] In the United States, radiopaque threads impregnated into surgical gauzes were first introduced in 1929 and were in general use by about 1940.[7] Some surgeons recommend routine postoperative X-ray films after surgery to reduce the likelihood of foreign body inclusion.[7]\n\nSee also \nRetained surgical instruments\nReferences \n\n\n^ a b c d e f Kim HS, Chung TS, Suh SH, Kim SY (April 2007). \"MR imaging findings of paravertebral gossypiboma\". AJNR Am J Neuroradiol. 28 (4): 709\u201313. PMID 17416826. \n\n^ a b Kiernan F, Joyce M, Byrnes CK, O'Grady H, Keane FB, Neary P (December 2008). \"Gossypiboma: a case report and review of the literature\". Ir J Med Sci. 177 (4): 389\u201391. doi:10.1007\/s11845-008-0197-0. PMID 18820991. \n\n^ a b Manzella A, Filho PB, Albuquerque E, Farias F, Kaercher J (December 2009). \"Imaging of gossypibomas: pictorial review\". AJR Am J Roentgenol. 193 (6 Suppl): S94\u2013101. doi:10.2214\/AJR.07.7132. PMID 19933682. \n\n^ \"Recommended practices for sponge, sharp, and instrument counts. AORN Recommended Practices Committee. Association of periOperative Registered Nurses\". AORN J. 70 (6): 1083\u20139. December 1999. doi:10.1016\/s0001-2092(06)62224-2. PMID 10635432. \n\n^ \"The Retained Surgical Sponge\", Agency for Healthcare Research and Quality \n\n^ Gibbs VC, Coakley FD, Reines HD (May 2007). \"Preventable errors in the operating room: retained foreign bodies after surgery--Part I\". Curr Probl Surg. 44 (5): 281\u2013337. doi:10.1067\/j.cpsurg.2007.03.002. PMID 17512832. \n\n^ a b Shyung LR, Chang WH, Lin SC, Shih SC, Kao CR, Chou SY (February 2005). \"Report of gossypiboma from the standpoint in medicine and law\". World J. Gastroenterol. 11 (8): 1248\u20139. PMC 4250725 . PMID 15754416. Archived from the original on 2012-05-05. \n\n\nCamazine, Brian. \"The persistent problem of the retained foreign body\". The Journal of Family Practice. \nExternal links \nCase description and discussion\nOhio University, Data Matrix Integrity Test\nA unified system for gossypiboma prevention\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Gossypiboma\">https:\/\/www.limswiki.org\/index.php\/Gossypiboma<\/a>\n\t\t\t\t\tCategory: Healthcare termsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:56.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 566 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","9a987c700a3112a55a2b8d9a6ecb9a1f_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Gossypiboma skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Gossypiboma<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gossypiboma_01.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9f\/Gossypiboma_01.jpg\/220px-Gossypiboma_01.jpg\" width=\"220\" height=\"241\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gossypiboma_01.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Mini-laparotomy revealed gossypiboma (grasped by the clamp).<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gossypiboma_02.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7d\/Gossypiboma_02.jpg\/220px-Gossypiboma_02.jpg\" width=\"220\" height=\"150\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gossypiboma_02.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Surgical specimen (gossypiboma).<\/div><\/div><\/div>\n<p><b>Gossypiboma<\/b>, <b>textiloma<\/b> or more broadly <b>Retained Foreign Object (RFO)<\/b> is the technical term for a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgical<\/a> complications resulting from foreign materials, such as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_sponge\" class=\"mw-redirect\" title=\"Surgical sponge\" rel=\"external_link\" target=\"_blank\">surgical sponge<\/a>, accidentally left inside a patient's body. The term \"gossypiboma\" is derived from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Latin\" title=\"Latin\" rel=\"external_link\" target=\"_blank\">Latin<\/a> <i><a href=\"https:\/\/en.wiktionary.org\/wiki\/gossypium#Latin\" class=\"extiw\" title=\"wikt:gossypium\" rel=\"external_link\" target=\"_blank\">gossypium<\/a><\/i> (\u201ccotton wool, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cotton\" title=\"Cotton\" rel=\"external_link\" target=\"_blank\">cotton<\/a>\u201d) and the suffix <i><a href=\"https:\/\/en.wiktionary.org\/wiki\/-oma\" class=\"extiw\" title=\"wikt:-oma\" rel=\"external_link\" target=\"_blank\">-oma<\/a><\/i>, meaning a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumor\" class=\"mw-redirect\" title=\"Tumor\" rel=\"external_link\" target=\"_blank\">tumor<\/a> or growth, and describes a mass within a patient's body comprising a cotton matrix surrounded by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign_body_granuloma\" title=\"Foreign body granuloma\" rel=\"external_link\" target=\"_blank\">foreign body granuloma<\/a>.<sup id=\"rdp-ebb-cite_ref-Kim_et_al_1-0\" class=\"reference\"><a href=\"#cite_note-Kim_et_al-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Kiernan_2-0\" class=\"reference\"><a href=\"#cite_note-Kiernan-2\" rel=\"external_link\">[2]<\/a><\/sup> \"Textiloma\" is derived from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Textile\" title=\"Textile\" rel=\"external_link\" target=\"_blank\">textile<\/a> (surgical sponges have historically been made of cloth), and is used in place of gossypiboma due to the increasing use of synthetic materials in place of cotton.<sup id=\"rdp-ebb-cite_ref-Kim_et_al_1-1\" class=\"reference\"><a href=\"#cite_note-Kim_et_al-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Incidence_and_clinical_presentation\">Incidence and clinical presentation<\/span><\/h2>\n<p>The actual <a href=\"https:\/\/en.wikipedia.org\/wiki\/Incidence_(epidemiology)\" title=\"Incidence (epidemiology)\" rel=\"external_link\" target=\"_blank\">incidence<\/a> of gossypiboma is difficult to determine, possibly due to a reluctance to report occurrences arising from fear of legal repercussions, but retained surgical sponges is reported to occur once in every 3000 to 5000 abdominal operations<sup id=\"rdp-ebb-cite_ref-Kiernan_2-1\" class=\"reference\"><a href=\"#cite_note-Kiernan-2\" rel=\"external_link\">[2]<\/a><\/sup> and are most frequently discovered in the abdomen.<sup id=\"rdp-ebb-cite_ref-Manzella_et_al_3-0\" class=\"reference\"><a href=\"#cite_note-Manzella_et_al-3\" rel=\"external_link\">[3]<\/a><\/sup> The incidence of retained foreign bodies following surgery has a reported rate of 0.01% to 0.001%, of which gossypibomas make up 80% of cases.<sup id=\"rdp-ebb-cite_ref-Kim_et_al_1-2\" class=\"reference\"><a href=\"#cite_note-Kim_et_al-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Gossypibomas can often present, clinically or radiologically, similar to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumor\" class=\"mw-redirect\" title=\"Tumor\" rel=\"external_link\" target=\"_blank\">tumors<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abscess\" title=\"Abscess\" rel=\"external_link\" target=\"_blank\">abscesses<\/a>, with widely variable complications and manifestations, making diagnosis difficult and causing significant patient <a href=\"https:\/\/en.wikipedia.org\/wiki\/Morbidity\" class=\"mw-redirect\" title=\"Morbidity\" rel=\"external_link\" target=\"_blank\">morbidity<\/a>.<sup id=\"rdp-ebb-cite_ref-Manzella_et_al_3-1\" class=\"reference\"><a href=\"#cite_note-Manzella_et_al-3\" rel=\"external_link\">[3]<\/a><\/sup> Two major types of reaction occur in response to retained surgical foreign bodies. In the first type, an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abscess\" title=\"Abscess\" rel=\"external_link\" target=\"_blank\">abscess<\/a> may form with or without a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Secondary_infection\" class=\"mw-redirect\" title=\"Secondary infection\" rel=\"external_link\" target=\"_blank\">secondary bacterial infection<\/a>. The second reaction is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aseptic\" class=\"mw-redirect\" title=\"Aseptic\" rel=\"external_link\" target=\"_blank\">aseptic<\/a> fibrinous response, resulting in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_adhesion\" class=\"mw-redirect\" title=\"Tissue adhesion\" rel=\"external_link\" target=\"_blank\">tissue adhesions<\/a> and encapsulation and eventually <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign_body_granuloma\" title=\"Foreign body granuloma\" rel=\"external_link\" target=\"_blank\">foreign body granuloma<\/a>.<sup id=\"rdp-ebb-cite_ref-Kim_et_al_1-3\" class=\"reference\"><a href=\"#cite_note-Kim_et_al-1\" rel=\"external_link\">[1]<\/a><\/sup> Symptoms may not present for long periods of time, sometimes months or years following surgery.<sup id=\"rdp-ebb-cite_ref-Kim_et_al_1-4\" class=\"reference\"><a href=\"#cite_note-Kim_et_al-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Prevention\">Prevention<\/span><\/h2>\n<p>To prevent gossypiboma, sponges are counted by hand before and after surgeries. This method was codified into recommended guidelines in the 1970s by the Association of periOperative Registered Nurses (<a href=\"https:\/\/en.wikipedia.org\/wiki\/AORN\" class=\"mw-redirect\" title=\"AORN\" rel=\"external_link\" target=\"_blank\">AORN<\/a>).<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Four separate counts are recommended: the first when instruments and sponges are first unpackaged and set up, a second before the beginning of the surgical procedure, a third as closure begins, and a final count during final skin closure.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Other guidelines have been promoted by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_College_of_Surgeons\" title=\"American College of Surgeons\" rel=\"external_link\" target=\"_blank\">American College of Surgeons<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_Commission\" title=\"Joint Commission\" rel=\"external_link\" target=\"_blank\">Joint Commission<\/a>.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>In most countries, surgical sponges contain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiodensity\" title=\"Radiodensity\" rel=\"external_link\" target=\"_blank\">radiopaque<\/a> material that can be readily identified in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiographic\" class=\"mw-redirect\" title=\"Radiographic\" rel=\"external_link\" target=\"_blank\">radiographic<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography\" class=\"mw-redirect\" title=\"Computed tomography\" rel=\"external_link\" target=\"_blank\">CT<\/a> images, facilitating detection.<sup id=\"rdp-ebb-cite_ref-Kim_et_al_1-5\" class=\"reference\"><a href=\"#cite_note-Kim_et_al-1\" rel=\"external_link\">[1]<\/a><\/sup> In the United States, radiopaque threads impregnated into surgical gauzes were first introduced in 1929 and were in general use by about 1940.<sup id=\"rdp-ebb-cite_ref-Shyung_et_al_7-0\" class=\"reference\"><a href=\"#cite_note-Shyung_et_al-7\" rel=\"external_link\">[7]<\/a><\/sup> Some surgeons recommend routine postoperative <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray\" title=\"X-ray\" rel=\"external_link\" target=\"_blank\">X-ray<\/a> films after surgery to reduce the likelihood of foreign body inclusion.<sup id=\"rdp-ebb-cite_ref-Shyung_et_al_7-1\" class=\"reference\"><a href=\"#cite_note-Shyung_et_al-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Retained_surgical_instruments\" title=\"Retained surgical instruments\" rel=\"external_link\" target=\"_blank\">Retained surgical instruments<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-Kim_et_al-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Kim_et_al_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kim_et_al_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kim_et_al_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kim_et_al_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kim_et_al_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kim_et_al_1-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kim HS, Chung TS, Suh SH, Kim SY (April 2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ajnr.org\/cgi\/pmidlookup?view=long&pmid=17416826\" target=\"_blank\">\"MR imaging findings of paravertebral gossypiboma\"<\/a>. <i>AJNR Am J Neuroradiol<\/i>. <b>28<\/b> (4): 709\u201313. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17416826\" target=\"_blank\">17416826<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AJNR+Am+J+Neuroradiol&rft.atitle=MR+imaging+findings+of+paravertebral+gossypiboma&rft.volume=28&rft.issue=4&rft.pages=709-13&rft.date=2007-04&rft_id=info%3Apmid%2F17416826&rft.aulast=Kim&rft.aufirst=HS&rft.au=Chung%2C+TS&rft.au=Suh%2C+SH&rft.au=Kim%2C+SY&rft_id=http%3A%2F%2Fwww.ajnr.org%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D17416826&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGossypiboma\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Kiernan-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Kiernan_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Kiernan_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kiernan F, Joyce M, Byrnes CK, O'Grady H, Keane FB, Neary P (December 2008). \"Gossypiboma: a case report and review of the literature\". <i>Ir J Med Sci<\/i>. <b>177<\/b> (4): 389\u201391. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11845-008-0197-0\" target=\"_blank\">10.1007\/s11845-008-0197-0<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18820991\" target=\"_blank\">18820991<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ir+J+Med+Sci&rft.atitle=Gossypiboma%3A+a+case+report+and+review+of+the+literature&rft.volume=177&rft.issue=4&rft.pages=389-91&rft.date=2008-12&rft_id=info%3Adoi%2F10.1007%2Fs11845-008-0197-0&rft_id=info%3Apmid%2F18820991&rft.aulast=Kiernan&rft.aufirst=F&rft.au=Joyce%2C+M&rft.au=Byrnes%2C+CK&rft.au=O%27Grady%2C+H&rft.au=Keane%2C+FB&rft.au=Neary%2C+P&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGossypiboma\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Manzella_et_al-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Manzella_et_al_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Manzella_et_al_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Manzella A, Filho PB, Albuquerque E, Farias F, Kaercher J (December 2009). \"Imaging of gossypibomas: pictorial review\". <i>AJR Am J Roentgenol<\/i>. <b>193<\/b> (6 Suppl): S94\u2013101. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2214%2FAJR.07.7132\" target=\"_blank\">10.2214\/AJR.07.7132<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19933682\" target=\"_blank\">19933682<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AJR+Am+J+Roentgenol&rft.atitle=Imaging+of+gossypibomas%3A+pictorial+review&rft.volume=193&rft.issue=6+Suppl&rft.pages=S94-101&rft.date=2009-12&rft_id=info%3Adoi%2F10.2214%2FAJR.07.7132&rft_id=info%3Apmid%2F19933682&rft.aulast=Manzella&rft.aufirst=A&rft.au=Filho%2C+PB&rft.au=Albuquerque%2C+E&rft.au=Farias%2C+F&rft.au=Kaercher%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGossypiboma\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\"Recommended practices for sponge, sharp, and instrument counts. AORN Recommended Practices Committee. Association of periOperative Registered Nurses\". <i>AORN J<\/i>. <b>70<\/b> (6): 1083\u20139. December 1999. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fs0001-2092%2806%2962224-2\" target=\"_blank\">10.1016\/s0001-2092(06)62224-2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10635432\" target=\"_blank\">10635432<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AORN+J&rft.atitle=Recommended+practices+for+sponge%2C+sharp%2C+and+instrument+counts.+AORN+Recommended+Practices+Committee.+Association+of+periOperative+Registered+Nurses&rft.volume=70&rft.issue=6&rft.pages=1083-9&rft.date=1999-12&rft_id=info%3Adoi%2F10.1016%2Fs0001-2092%2806%2962224-2&rft_id=info%3Apmid%2F10635432&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGossypiboma\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ahrq.gov\/clinic\/ptsafety\/chap22.htm\" target=\"_blank\">\"The Retained Surgical Sponge\"<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Agency_for_Healthcare_Research_and_Quality\" title=\"Agency for Healthcare Research and Quality\" rel=\"external_link\" target=\"_blank\">Agency for Healthcare Research and Quality<\/a><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gibbs VC, Coakley FD, Reines HD (May 2007). \"Preventable errors in the operating room: retained foreign bodies after surgery--Part I\". <i>Curr Probl Surg<\/i>. <b>44<\/b> (5): 281\u2013337. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1067%2Fj.cpsurg.2007.03.002\" target=\"_blank\">10.1067\/j.cpsurg.2007.03.002<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17512832\" target=\"_blank\">17512832<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Curr+Probl+Surg&rft.atitle=Preventable+errors+in+the+operating+room%3A+retained+foreign+bodies+after+surgery--Part+I&rft.volume=44&rft.issue=5&rft.pages=281-337&rft.date=2007-05&rft_id=info%3Adoi%2F10.1067%2Fj.cpsurg.2007.03.002&rft_id=info%3Apmid%2F17512832&rft.aulast=Gibbs&rft.aufirst=VC&rft.au=Coakley%2C+FD&rft.au=Reines%2C+HD&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGossypiboma\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Shyung_et_al-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Shyung_et_al_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Shyung_et_al_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Shyung LR, Chang WH, Lin SC, Shih SC, Kao CR, Chou SY (February 2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120505172540\/http:\/\/www.wjgnet.com\/1007-9327\/11\/1248.asp\" target=\"_blank\">\"Report of gossypiboma from the standpoint in medicine and law\"<\/a>. <i>World J. Gastroenterol<\/i>. <b>11<\/b> (8): 1248\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4250725\" target=\"_blank\">4250725<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15754416\" target=\"_blank\">15754416<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.wjgnet.com\/1007-9327\/11\/1248.asp\" target=\"_blank\">the original<\/a> on 2012-05-05.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=World+J.+Gastroenterol.&rft.atitle=Report+of+gossypiboma+from+the+standpoint+in+medicine+and+law&rft.volume=11&rft.issue=8&rft.pages=1248-9&rft.date=2005-02&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4250725&rft_id=info%3Apmid%2F15754416&rft.aulast=Shyung&rft.aufirst=LR&rft.au=Chang%2C+WH&rft.au=Lin%2C+SC&rft.au=Shih%2C+SC&rft.au=Kao%2C+CR&rft.au=Chou%2C+SY&rft_id=http%3A%2F%2Fwww.wjgnet.com%2F1007-9327%2F11%2F1248.asp&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGossypiboma\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<ul><li><cite class=\"citation journal\">Camazine, Brian. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jfponline.com\/Pages.asp?AID=2068\" target=\"_blank\">\"The persistent problem of the retained foreign body\"<\/a>. <i>The Journal of Family Practice<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Family+Practice&rft.atitle=The+persistent+problem+of+the+retained+foreign+body&rft.au=Camazine%2C+Brian&rft_id=http%3A%2F%2Fwww.jfponline.com%2FPages.asp%3FAID%3D2068&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGossypiboma\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/brighamrad.harvard.edu\/Cases\/bwh\/hcache\/391\/full.html\" target=\"_blank\">Case description and discussion<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ent.ohiou.edu\/autoid\/datam417.pdf\" target=\"_blank\">Ohio University, Data Matrix Integrity Test<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.kalyspo.com\" target=\"_blank\">A unified system for gossypiboma prevention<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1328\nCached time: 20181216122007\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.196 seconds\nReal time usage: 0.245 seconds\nPreprocessor visited node count: 453\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 13707\/2097152 bytes\nTemplate argument size: 75\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 21300\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.132\/10.000 seconds\nLua memory usage: 2.72 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 196.386 1 -total\n<\/p>\n<pre>97.68% 191.833 1 Template:Reflist\n88.62% 174.030 7 Template:Cite_journal\n 1.47% 2.884 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:4087651-1!canonical and timestamp 20181216122006 and revision id 795242798\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gossypiboma\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214710\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.009 seconds\nReal time usage: 0.151 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 145.507 1 - wikipedia:Gossypiboma\n100.00% 145.507 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8576-0!*!*!*!*!*!* and timestamp 20181217214710 and revision id 25004\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Gossypiboma\">https:\/\/www.limswiki.org\/index.php\/Gossypiboma<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","9a987c700a3112a55a2b8d9a6ecb9a1f_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9f\/Gossypiboma_01.jpg\/440px-Gossypiboma_01.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7d\/Gossypiboma_02.jpg\/440px-Gossypiboma_02.jpg"],"9a987c700a3112a55a2b8d9a6ecb9a1f_timestamp":1545083230,"aec7ce92977c5ced7bcf01212f077879_type":"article","aec7ce92977c5ced7bcf01212f077879_title":"Companion diagnostic","aec7ce92977c5ced7bcf01212f077879_url":"https:\/\/www.limswiki.org\/index.php\/Companion_diagnostic","aec7ce92977c5ced7bcf01212f077879_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCompanion diagnostic\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article has multiple issues. 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(June 2016) (Learn how and when to remove this template message)\n \n (Learn how and when to remove this template message)\nCompanion diagnosticMedical diagnosticsPurposeto determine the correct therapeutic agent for an individual\nA companion diagnostic (CDx)[1] is a diagnostic test used as a companion to a therapeutic drug to determine its applicability to a specific person.[2]\nCompanion diagnostics are co-developed with drugs to aid in selecting or excluding patient groups for treatment with that particular drug on the basis of their biological characteristics that determine responders and non-responders to the therapy.[3]\nCompanion diagnostics are developed based on companion biomarkers, biomarkers that prospectively help predict likely response or severe toxicity.[4]\n\nSee also \nPersonalized medicine\nPrecision medicine\nReferences \n\n\n^ \"Pfizer Taps Foundation Medicine for CDx Development\". Clinical OMICs. 16 January 2018. Retrieved 19 January 2018 . \n\n^ \"Companion Diagnostics\" (Page Last Updated 07\/14\/2016) . FDA. Retrieved 26 September 2016 . \n\n^ Trusheim, MR; Burgess, B; Hu, SX; Long, T; Averbuch, SD; Flynn, AA; Lieftucht, A; Mazumder, A; Milloy, J; Shaw, PM; Swank, D; Wang, J; Berndt, ER; Goodsaid, F; Palmer, MC (31 October 2011). \"Quantifying factors for the success of stratified medicine\". Nature Reviews. Drug Discovery. 10 (11): 817\u201333. doi:10.1038\/nrd3557. PMID 22037040. \n\n^ Duffy, MJ; Crown, J (October 2013). \"Companion biomarkers: paving the pathway to personalized treatment for cancer\". Clinical chemistry. 59 (10): 1447\u201356. doi:10.1373\/clinchem.2012.200477. PMID 23656699. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Companion_diagnostic\">https:\/\/www.limswiki.org\/index.php\/Companion_diagnostic<\/a>\n\t\t\t\t\tCategories: Medical and surgical techniquesMedical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:54.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 408 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","aec7ce92977c5ced7bcf01212f077879_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Companion_diagnostic skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Companion diagnostic<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p>A <b>companion diagnostic<\/b> (CDx)<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diagnostic_test\" class=\"mw-redirect\" title=\"Diagnostic test\" rel=\"external_link\" target=\"_blank\">diagnostic test<\/a> used as a companion to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacology\" title=\"Pharmacology\" rel=\"external_link\" target=\"_blank\">therapeutic drug<\/a> to determine its applicability to a specific person.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Companion diagnostics are co-developed with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug\" title=\"Drug\" rel=\"external_link\" target=\"_blank\">drugs<\/a> to aid in selecting or excluding patient groups for treatment with that particular drug on the basis of their biological characteristics that determine responders and non-responders to the therapy.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>Companion diagnostics are developed based on <b>companion biomarkers<\/b>, biomarkers that prospectively help predict likely response or severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxicity\" title=\"Toxicity\" rel=\"external_link\" target=\"_blank\">toxicity<\/a>.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Personalized_medicine\" title=\"Personalized medicine\" rel=\"external_link\" target=\"_blank\">Personalized medicine<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Precision_medicine\" title=\"Precision medicine\" rel=\"external_link\" target=\"_blank\">Precision medicine<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.clinicalomics.com\/articles\/cancer-cdx-collaboration-brings-foundation-medicine-and-pfizer-together\/1433\" target=\"_blank\">\"Pfizer Taps Foundation Medicine for CDx Development\"<\/a>. <i>Clinical OMICs<\/i>. 16 January 2018<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 January<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+OMICs&rft.atitle=Pfizer+Taps+Foundation+Medicine+for+CDx+Development&rft.date=2018-01-16&rft_id=https%3A%2F%2Fwww.clinicalomics.com%2Farticles%2Fcancer-cdx-collaboration-brings-foundation-medicine-and-pfizer-together%2F1433&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACompanion+diagnostic\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/InVitroDiagnostics\/ucm407297.htm\" target=\"_blank\">\"Companion Diagnostics\"<\/a> <span class=\"cs1-format\">(Page Last Updated 07\/14\/2016)<\/span>. FDA<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">26 September<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Companion+Diagnostics&rft.pub=FDA&rft_id=http%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FProductsandMedicalProcedures%2FInVitroDiagnostics%2Fucm407297.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACompanion+diagnostic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Trusheim, MR; Burgess, B; Hu, SX; Long, T; Averbuch, SD; Flynn, AA; Lieftucht, A; Mazumder, A; Milloy, J; Shaw, PM; Swank, D; Wang, J; Berndt, ER; Goodsaid, F; Palmer, MC (31 October 2011). \"Quantifying factors for the success of stratified medicine\". <i>Nature Reviews. Drug Discovery<\/i>. <b>10<\/b> (11): 817\u201333. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fnrd3557\" target=\"_blank\">10.1038\/nrd3557<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22037040\" target=\"_blank\">22037040<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Reviews.+Drug+Discovery&rft.atitle=Quantifying+factors+for+the+success+of+stratified+medicine.&rft.volume=10&rft.issue=11&rft.pages=817-33&rft.date=2011-10-31&rft_id=info%3Adoi%2F10.1038%2Fnrd3557&rft_id=info%3Apmid%2F22037040&rft.aulast=Trusheim&rft.aufirst=MR&rft.au=Burgess%2C+B&rft.au=Hu%2C+SX&rft.au=Long%2C+T&rft.au=Averbuch%2C+SD&rft.au=Flynn%2C+AA&rft.au=Lieftucht%2C+A&rft.au=Mazumder%2C+A&rft.au=Milloy%2C+J&rft.au=Shaw%2C+PM&rft.au=Swank%2C+D&rft.au=Wang%2C+J&rft.au=Berndt%2C+ER&rft.au=Goodsaid%2C+F&rft.au=Palmer%2C+MC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACompanion+diagnostic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Duffy, MJ; Crown, J (October 2013). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/clinchem.aaccjnls.org\/content\/59\/10\/1447.long\" target=\"_blank\">\"Companion biomarkers: paving the pathway to personalized treatment for cancer\"<\/a>. <i>Clinical chemistry<\/i>. <b>59<\/b> (10): 1447\u201356. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1373%2Fclinchem.2012.200477\" target=\"_blank\">10.1373\/clinchem.2012.200477<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23656699\" target=\"_blank\">23656699<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+chemistry&rft.atitle=Companion+biomarkers%3A+paving+the+pathway+to+personalized+treatment+for+cancer.&rft.volume=59&rft.issue=10&rft.pages=1447-56&rft.date=2013-10&rft_id=info%3Adoi%2F10.1373%2Fclinchem.2012.200477&rft_id=info%3Apmid%2F23656699&rft.aulast=Duffy&rft.aufirst=MJ&rft.au=Crown%2C+J&rft_id=http%3A%2F%2Fclinchem.aaccjnls.org%2Fcontent%2F59%2F10%2F1447.long&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACompanion+diagnostic\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1251\nCached time: 20181207083310\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.220 seconds\nReal time usage: 0.319 seconds\nPreprocessor visited node count: 878\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 36951\/2097152 bytes\nTemplate argument size: 8486\/2097152 bytes\nHighest expansion depth: 19\/40\nExpensive parser function count: 7\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 11540\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.125\/10.000 seconds\nLua memory usage: 3.11 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 274.846 1 -total\n<\/p>\n<pre>48.90% 134.391 3 Template:Ambox\n46.94% 129.022 1 Template:Reflist\n40.03% 110.008 1 Template:Multiple_issues\n22.60% 62.110 1 Template:Cite_news\n16.47% 45.262 2 Template:Cite_journal\n13.68% 37.595 1 Template:Cleanup\n11.74% 32.267 1 Template:Infobox_diagnostic\n11.02% 30.282 1 Template:Underlinked\n10.38% 28.526 1 Template:Infobox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:42275348-1!canonical and timestamp 20181207083309 and revision id 872202158\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Companion_diagnostic\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214710\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.009 seconds\nReal time usage: 0.151 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 145.380 1 - wikipedia:Companion_diagnostic\n100.00% 145.380 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8575-0!*!*!*!*!*!* and timestamp 20181217214710 and revision id 25003\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Companion_diagnostic\">https:\/\/www.limswiki.org\/index.php\/Companion_diagnostic<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","aec7ce92977c5ced7bcf01212f077879_images":[],"aec7ce92977c5ced7bcf01212f077879_timestamp":1545083230,"b80050a8a33e647be9f7402bb654ba06_type":"article","b80050a8a33e647be9f7402bb654ba06_title":"Central sterile services department","b80050a8a33e647be9f7402bb654ba06_url":"https:\/\/www.limswiki.org\/index.php\/Central_sterile_services_department","b80050a8a33e647be9f7402bb654ba06_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCentral sterile services department\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThe central sterile services department (CSSD), also called sterile processing department (SPD), sterile processing, central supply department (CSD), or central supply, is an integrated place in hospitals and other health care facilities that performs sterilization and other actions on medical devices, equipment and consumables; for subsequent use by health workers in the operating theatre of the hospital and also for other aseptic procedures, e.g. catheterization, wound stitching and bandaging in a medical, surgical, maternity or paediatric ward.[1]\n\nContents \n\n1 Background \n2 Sterilization methods in use \n3 Sterile processing technician \n4 Departments \n\n4.1 Decontamination \n4.2 Sterilization and storage \n4.3 Distribution \n\n\n5 See also \n6 References \n\n\nBackground \nThe operations of a sterile services department usually consist of the cleaning, disinfection, and sterilization of reusable medical equipment. Reusable medical equipment, or RME, can consist of any medical equipment from stainless steel surgical instrumentation, to IV pumps and crash carts. RME is separated into three classes: non-critical, semi-critical, and critical, with each class requiring a minimum level of reprocessing[2].\nNon-critical items, such as IV poles and pumps, require a minimum of intermediate level disinfection which can be accomplished with most hospital disinfectants[2].\nSemi-critical items are items that are expected to have contact with what an intact mucous membrane, and normally consists of endoscopes like those used in colonoscopies.\nThese items require high level disinfectants such as glutaraldehyde solution, peracetic acid, or hydrogen peroxide plasma[2].\n\n<\/p>Critical items, which include any instrument which will be introduced into a patient blood stream or in a normally sterile area of the body, require sterilization[2].\n\nSterilization methods in use \nMain article: Sterilization (microbiology)\nSterilization is the process of destroying all living organisms on an item and is the main task of most sterile services departments. Items to be sterilized must first be cleaned in a separate decontamination room and inspected for effectiveness, cleanliness and damage. There are multiple methods of sterilization, and which one is used is dependant on many factors including: operational cost, potential hazards to workers, efficacy, time, and composition of the materials being sterilized.\nIn the US, one of the cheapest and easiest methods is steam sterilization, where instrumentation trays and packages are placed in a chamber which is them filled with 250\u2013270 \u00b0F (121\u2013132 \u00b0C) steam, killing all microorganisms[3].\nSterilization can also be achieved using ethylene oxide (ETO) gas. This process was created in the 1950s by the US military[4] and is used on items that cannot withstand the high temperatures of steam sterilization. ETO sterilization takes far longer than steam sterilization and is hazardous to workers, so alternative methods were created in the 1990s. The most common method for sterilizing at low temperatures today is by using hydrogen peroxide plasma, which has near zero risk to workers and cycles take a fraction of the time of ETO sterilization.\nDepending on the healthcare facility's policy, there will be either an event related or time related sterile storage policy. If the policy is time related, an expiration date is placed on the sterile package, before being supplied to the end-user as a sterile product. If along the supply route, the sealed package got damaged or opened by a health worker, it needs to be returned to the CSSD for re-sterilization. If the healthcare facility's policy is event related, the package is considered sterile until an event occurs to compromise it's sterility (e.g. opened, dropped package, high humidity conditions, torn muslin wrap, etc.)\n\nSterile processing technician \nA sterile processing technician is someone who cleans and sterilizes used surgical instruments and other medical supplies so that they can be safely redistributed and reused on future patients. This work is usually centralized in a special department of the medical facility.\nJob titles include the following: \n\nSterile processing and distribution technician (SPD tech or CPD tech)\nCentral sterile supply technician (CSS tech)\nCentral processing technician (CPT)\nCentral service technician (CST)\nCertified Sterile Science Technician (CSST)\nSterile Science Associate(SSA)- Degree.\nSterile Scientist (SS)- Degree.\nMaster of Sterile Sciences (MSS)- Degree.\nDepartments \nThis section does not cite any sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (October 2018) (Learn how and when to remove this template message)\nSterile processing departments are typically divided into four major areas to accomplish the functions of decontamination, assembly and sterile processing, sterile storage, and distribution.\n\nDecontamination \nDecontaminating used surgical instruments and other medical devices\nOperating and maintaining special decontamination equipment like automatic washers\nInspecting decontaminated items to make sure they are clean\nAssembly\nOrganizing clean items and packaging them into appropriate instrument trays and sets\nSterilization and storage \nSterilizing assembled trays of instruments\nPrecisely operating and monitoring special sterilization equipment like autoclaves\nKeeping detailed records of items that have been cleaned, sterilized, and stored\nDistribution \nStocking crash carts\nOrganizing sterilized medical supplies\nEnsuring that sterile supplies don\u2019t become outdated \/ preventing event related sterility issues\nDelivering sterile supplies where they are needed and picking up dirty ones\nSee also \nAutoclave\nHospital warehouse\nSterilization (microbiology)\nReferences \n\n\n^ \"Sterilization basics\". University of Rochester. Retrieved 16 June 2016 . \n\n^ a b c d Health, Center for Devices and Radiological. \"Reprocessing of Reusable Medical Devices - What are Reusable Medical Devices?\". www.fda.gov. Retrieved 2018-10-17 . \n\n^ Rutala, W. A.; Stiegel, M. M.; Sarubbi, F. A. (1982-06-01). \"Decontamination of laboratory microbiological waste by steam sterilization\". Appl. Environ. Microbiol. 43 (6): 1311\u20131316. ISSN 0099-2240. PMID 7103486. \n\n^ Reichert, Marimargaret; Young, Jack H. (1997). Sterilization Technology for the Health Care Facility. Jones & Bartlett Learning. ISBN 9780834208384. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Central_sterile_services_department\">https:\/\/www.limswiki.org\/index.php\/Central_sterile_services_department<\/a>\n\t\t\t\t\tCategory: Healthcare settingsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:52.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 468 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","b80050a8a33e647be9f7402bb654ba06_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Central_sterile_services_department skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Central sterile services department<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>The <b>central sterile services department<\/b> (<b>CSSD<\/b>), also called <b>sterile processing department<\/b> (<b>SPD<\/b>), <b>sterile processing<\/b>, <b>central supply department<\/b> (<b>CSD<\/b>), or <b>central supply<\/b>, is an integrated place in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital\" title=\"Hospital\" rel=\"external_link\" target=\"_blank\">hospitals<\/a> and other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care\" title=\"Health care\" rel=\"external_link\" target=\"_blank\">health care<\/a> facilities that performs <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">sterilization<\/a> and other actions on medical devices, equipment and consumables; for subsequent use by health workers in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Operating_theatre\" class=\"mw-redirect\" title=\"Operating theatre\" rel=\"external_link\" target=\"_blank\">operating theatre<\/a> of the hospital and also for other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Asepsis\" title=\"Asepsis\" rel=\"external_link\" target=\"_blank\">aseptic<\/a> procedures, e.g. catheterization, wound stitching and bandaging in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical\" class=\"mw-redirect\" title=\"Medical\" rel=\"external_link\" target=\"_blank\">medical<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical\" class=\"mw-redirect\" title=\"Surgical\" rel=\"external_link\" target=\"_blank\">surgical<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Maternity\" class=\"mw-redirect\" title=\"Maternity\" rel=\"external_link\" target=\"_blank\">maternity<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paediatric\" class=\"mw-redirect\" title=\"Paediatric\" rel=\"external_link\" target=\"_blank\">paediatric<\/a> ward.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Background\">Background<\/span><\/h2>\n<p>The operations of a sterile services department usually consist of the cleaning, disinfection, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">sterilization<\/a> of reusable medical equipment. Reusable medical equipment, or RME, can consist of any medical equipment from stainless steel surgical instrumentation, to IV pumps and crash carts. RME is separated into three classes: non-critical, semi-critical, and critical, with each class requiring a minimum level of reprocessing<sup id=\"rdp-ebb-cite_ref-fda.gov-what-is-rme_2-0\" class=\"reference\"><a href=\"#cite_note-fda.gov-what-is-rme-2\" rel=\"external_link\">[2]<\/a><\/sup>.\n<\/p><p>Non-critical items, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy\" title=\"Intravenous therapy\" rel=\"external_link\" target=\"_blank\">IV<\/a> poles and pumps, require a minimum of intermediate level disinfection which can be accomplished with most hospital disinfectants<sup id=\"rdp-ebb-cite_ref-fda.gov-what-is-rme_2-1\" class=\"reference\"><a href=\"#cite_note-fda.gov-what-is-rme-2\" rel=\"external_link\">[2]<\/a><\/sup>.\n<\/p><p>Semi-critical items are items that are expected to have contact with what an intact <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mucous_membrane\" title=\"Mucous membrane\" rel=\"external_link\" target=\"_blank\">mucous membrane<\/a>, and normally consists of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopy\" title=\"Endoscopy\" rel=\"external_link\" target=\"_blank\">endoscopes<\/a> like those used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colonoscopy\" title=\"Colonoscopy\" rel=\"external_link\" target=\"_blank\">colonoscopies<\/a>.\n<p>These items require high level <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disinfectant\" title=\"Disinfectant\" rel=\"external_link\" target=\"_blank\">disinfectants<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glutaraldehyde\" title=\"Glutaraldehyde\" rel=\"external_link\" target=\"_blank\">glutaraldehyde solution<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peracetic_acid\" title=\"Peracetic acid\" rel=\"external_link\" target=\"_blank\">peracetic acid<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)#Hydrogen_peroxide\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">hydrogen peroxide plasma<\/a><sup id=\"rdp-ebb-cite_ref-fda.gov-what-is-rme_2-2\" class=\"reference\"><a href=\"#cite_note-fda.gov-what-is-rme-2\" rel=\"external_link\">[2]<\/a><\/sup>.\n<\/p>\n<\/p><p>Critical items, which include any instrument which will be introduced into a patient blood stream or in a normally sterile area of the body, require sterilization<sup id=\"rdp-ebb-cite_ref-fda.gov-what-is-rme_2-3\" class=\"reference\"><a href=\"#cite_note-fda.gov-what-is-rme-2\" rel=\"external_link\">[2]<\/a><\/sup>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Sterilization_methods_in_use\">Sterilization methods in use<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">Sterilization (microbiology)<\/a><\/div>\n<p>Sterilization is the process of destroying all living organisms on an item and is the main task of most sterile services departments. Items to be sterilized must first be cleaned in a separate decontamination room and inspected for effectiveness, cleanliness and damage. There are multiple methods of sterilization, and which one is used is dependant on many factors including: operational cost, potential hazards to workers, efficacy, time, and composition of the materials being sterilized.\n<\/p><p>In the US, one of the cheapest and easiest methods is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Moist_heat_sterilization\" title=\"Moist heat sterilization\" rel=\"external_link\" target=\"_blank\">steam sterilization<\/a>, where instrumentation trays and packages are placed in a chamber which is them filled with 250\u2013270 \u00b0F (121\u2013132 \u00b0C) steam, killing all microorganisms<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>.\n<\/p><p>Sterilization can also be achieved using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_oxide\" title=\"Ethylene oxide\" rel=\"external_link\" target=\"_blank\">ethylene oxide<\/a> (ETO) gas. This process was created in the 1950s by the US military<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> and is used on items that cannot withstand the high temperatures of steam sterilization. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_oxide#Healthcare_sterilant\" title=\"Ethylene oxide\" rel=\"external_link\" target=\"_blank\">ETO sterilization<\/a> takes far longer than steam sterilization and is hazardous to workers, so alternative methods were created in the 1990s. The most common method for sterilizing at low temperatures today is by using hydrogen peroxide plasma, which has near zero risk to workers and cycles take a fraction of the time of ETO sterilization.\n<\/p><p>Depending on the healthcare facility's policy, there will be either an event related or time related sterile storage policy. If the policy is time related, an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Expiry_date\" class=\"mw-redirect\" title=\"Expiry date\" rel=\"external_link\" target=\"_blank\">expiration date<\/a> is placed on the sterile package, before being supplied to the end-user as a <i>sterile<\/i> product. If along the supply route, the sealed package got damaged or opened by a health worker, it needs to be returned to the CSSD for re-sterilization. If the healthcare facility's policy is event related, the package is considered sterile until an event occurs to compromise it's sterility (e.g. opened, dropped package, high humidity conditions, torn muslin wrap, etc.)\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Sterile_processing_technician\">Sterile processing technician<\/span><\/h2>\n<p>A sterile processing technician is someone who cleans and sterilizes used <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instruments\" class=\"mw-redirect\" title=\"Surgical instruments\" rel=\"external_link\" target=\"_blank\">surgical instruments<\/a> and other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_supplies\" class=\"mw-redirect\" title=\"Medical supplies\" rel=\"external_link\" target=\"_blank\">medical supplies<\/a> so that they can be safely redistributed and reused on future patients. This work is usually centralized in a special department of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_facility\" class=\"mw-redirect\" title=\"Medical facility\" rel=\"external_link\" target=\"_blank\">medical facility<\/a>.\n<\/p><p>Job titles include the following: \n<\/p>\n<ul><li>Sterile processing and distribution technician (SPD tech or CPD tech)<\/li>\n<li>Central sterile supply technician (CSS tech)<\/li>\n<li>Central processing technician (CPT)<\/li>\n<li>Central service technician (CST)<\/li>\n<li>Certified Sterile Science Technician (CSST)<\/li>\n<li>Sterile Science Associate(SSA)- Degree.<\/li>\n<li>Sterile Scientist (SS)- Degree.<\/li>\n<li>Master of Sterile Sciences (MSS)- Degree.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Departments\">Departments<\/span><\/h2>\n\n<p>Sterile processing departments are typically divided into four major areas to accomplish the functions of decontamination, assembly and sterile processing, sterile storage, and distribution.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Decontamination\">Decontamination<\/span><\/h3>\n<ul><li>Decontaminating used surgical instruments and other medical devices<\/li>\n<li>Operating and maintaining special decontamination equipment like automatic washers<\/li>\n<li>Inspecting decontaminated items to make sure they are clean<\/li>\n<li>Assembly<\/li>\n<li>Organizing clean items and packaging them into appropriate instrument trays and sets<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Sterilization_and_storage\">Sterilization and storage<\/span><\/h3>\n<ul><li>Sterilizing assembled trays of instruments<\/li>\n<li>Precisely operating and monitoring special sterilization equipment like autoclaves<\/li>\n<li>Keeping detailed records of items that have been cleaned, sterilized, and stored<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Distribution\">Distribution<\/span><\/h3>\n<ul><li>Stocking crash carts<\/li>\n<li>Organizing sterilized medical supplies<\/li>\n<li>Ensuring that sterile supplies don\u2019t become outdated \/ preventing event related sterility issues<\/li>\n<li>Delivering sterile supplies where they are needed and picking up dirty ones<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Autoclave\" title=\"Autoclave\" rel=\"external_link\" target=\"_blank\">Autoclave<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hospital_warehouse\" title=\"Hospital warehouse\" rel=\"external_link\" target=\"_blank\">Hospital warehouse<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">Sterilization (microbiology)<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.urmc.rochester.edu\/sterile\/basics.aspx\" target=\"_blank\">\"Sterilization basics\"<\/a>. University of Rochester<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">16 June<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Sterilization+basics&rft.pub=University+of+Rochester&rft_id=https%3A%2F%2Fwww.urmc.rochester.edu%2Fsterile%2Fbasics.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACentral+sterile+services+department\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-fda.gov-what-is-rme-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-fda.gov-what-is-rme_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fda.gov-what-is-rme_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fda.gov-what-is-rme_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-fda.gov-what-is-rme_2-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Health, Center for Devices and Radiological. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.fda.gov\/MedicalDevices\/ProductsandMedicalProcedures\/ReprocessingofReusableMedicalDevices\/ucm454619.htm\" target=\"_blank\">\"Reprocessing of Reusable Medical Devices - What are Reusable Medical Devices?\"<\/a>. <i>www.fda.gov<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-10-17<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.fda.gov&rft.atitle=Reprocessing+of+Reusable+Medical+Devices+-+What+are+Reusable+Medical+Devices%3F&rft.aulast=Health&rft.aufirst=Center+for+Devices+and+Radiological&rft_id=https%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FProductsandMedicalProcedures%2FReprocessingofReusableMedicalDevices%2Fucm454619.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACentral+sterile+services+department\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rutala, W. A.; Stiegel, M. M.; Sarubbi, F. A. (1982-06-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/aem.asm.org\/content\/43\/6\/1311\" target=\"_blank\">\"Decontamination of laboratory microbiological waste by steam sterilization\"<\/a>. <i>Appl. Environ. Microbiol<\/i>. <b>43<\/b> (6): 1311\u20131316. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0099-2240\" target=\"_blank\">0099-2240<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7103486\" target=\"_blank\">7103486<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Appl.+Environ.+Microbiol.&rft.atitle=Decontamination+of+laboratory+microbiological+waste+by+steam+sterilization.&rft.volume=43&rft.issue=6&rft.pages=1311-1316&rft.date=1982-06-01&rft_id=info%3Apmid%2F7103486&rft.issn=0099-2240&rft.aulast=Rutala&rft.aufirst=W.+A.&rft.au=Stiegel%2C+M.+M.&rft.au=Sarubbi%2C+F.+A.&rft_id=https%3A%2F%2Faem.asm.org%2Fcontent%2F43%2F6%2F1311&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACentral+sterile+services+department\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Reichert, Marimargaret; Young, Jack H. (1997). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.co.uk\/books?id=HDzcboqJR9kC&dq=eto+sterilization+us+military&source=gbs_navlinks_s\" target=\"_blank\"><i>Sterilization Technology for the Health Care Facility<\/i><\/a>. Jones & Bartlett Learning. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780834208384.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Sterilization+Technology+for+the+Health+Care+Facility&rft.pub=Jones+%26+Bartlett+Learning&rft.date=1997&rft.isbn=9780834208384&rft.aulast=Reichert&rft.aufirst=Marimargaret&rft.au=Young%2C+Jack+H.&rft_id=https%3A%2F%2Fbooks.google.co.uk%2Fbooks%3Fid%3DHDzcboqJR9kC%26dq%3Deto%2Bsterilization%2Bus%2Bmilitary%26source%3Dgbs_navlinks_s&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACentral+sterile+services+department\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1273\nCached time: 20181129163723\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.204 seconds\nReal time usage: 0.286 seconds\nPreprocessor visited node count: 402\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 14170\/2097152 bytes\nTemplate argument size: 171\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 11904\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.118\/10.000 seconds\nLua memory usage: 3.99 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 244.583 1 -total\n<\/p>\n<pre>49.41% 120.840 1 Template:Reflist\n27.95% 68.368 2 Template:Cite_web\n20.05% 49.045 1 Template:Unreferenced_section\n17.98% 43.970 1 Template:Convert\n17.82% 43.592 1 Template:Unreferenced\n16.43% 40.186 1 Template:Ambox\n11.84% 28.950 1 Template:Main_article\n11.54% 28.226 1 Template:Cite_paper\n 3.01% 7.374 1 Template:Cite_book\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:38059582-1!canonical and timestamp 20181129163722 and revision id 865396486\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Central_sterile_services_department\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214709\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.138 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 132.465 1 - wikipedia:Central_sterile_services_department\n100.00% 132.465 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8574-0!*!*!*!*!*!* and timestamp 20181217214709 and revision id 25002\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Central_sterile_services_department\">https:\/\/www.limswiki.org\/index.php\/Central_sterile_services_department<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","b80050a8a33e647be9f7402bb654ba06_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png"],"b80050a8a33e647be9f7402bb654ba06_timestamp":1545083229,"8242550c187fa50d6e13369341156e6c_type":"article","8242550c187fa50d6e13369341156e6c_title":"Biocompatibility","8242550c187fa50d6e13369341156e6c_url":"https:\/\/www.limswiki.org\/index.php\/Biocompatibility","8242550c187fa50d6e13369341156e6c_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tBiocompatibility\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (December 2011) (Learn how and when to remove this template message)\nBiocompatibility is related to the behavior of biomaterials in various contexts. The term refers to the ability of a material to perform with an appropriate host response in a specific situation.[1] The ambiguity of the term reflects the ongoing development of insights into how biomaterials interact with the human body and eventually how those interactions determine the clinical success of a medical device (such as pacemaker, hip replacement or stent). Modern medical devices and prostheses are often made of more than one material so it might not always be sufficient to talk about the biocompatibility of a specific material.[2]\nSince the immune response and repair functions in the body are so complicated it is not adequate to describe the biocompatibility of a single material in relation to a single cell type or tissue. Sometimes one hears of biocompatibility testing that is a large battery of in vitro test[3] that is used in accordance with ISO 10993 (or other similar standards) to determine if a certain material (or rather biomedical product) is biocompatible. These tests do not determine the biocompatibility of a material,[4] but they constitute an important step towards the animal testing and finally clinical trials that will determine the biocompatibility of the material in a given application, and thus medical devices such as implants or drug delivery devices[5].\n\n\nIUPAC definition\nBiocompatibility (biomedical therapy): Ability of a material to perform with an appropriate host response in a specific application.[6][a]\r\n\nBiocompatibility: Ability to be in contact with a living system without producing an adverse effect.[6]\n\n\nContents \n\n1 History \n2 Five definitions of biocompatibility \n3 Comments on the above five definitions \n\n3.1 \u2018Biocompatible\u2019 \n3.2 Suggested sub-definitions \n\n\n4 See also \n5 References \n\n\nHistory \nThe word biocompatibility seems to have been mentioned for the first time in peer-review journals and meetings in 1970 by RJ Hegyeli (Amer Chem Soc Annual Meeting abstract) and CA Homsy et al. (J Macromol Sci Chem A4:3,615, 1970). It took almost two decades before it began to be commonly used in scientific literature (see the graph below).\nRecently Williams (again) has been trying to reevaluate the current knowledge status regarding what factors determine clinical success. Doing so notes that an implant may not always have to be positively bioactive but it must not do any harm (either locally or systemically) (Williams, 2008).\n\nFive definitions of biocompatibility \n\"The quality of not having toxic or injurious effects on biological systems\".[7]\n\"The ability of a material to perform with an appropriate host response in a specific application\", Williams' definition.[8]\n\"Comparison of the tissue response produced through the close association of the implanted candidate material to its implant site within the host animal to that tissue response recognised and established as suitable with control materials\" - ASTM\n\"Refers to the ability of a biomaterial to perform its desired function with respect to a medical therapy, without eliciting any undesirable local or systemic effects in the recipient or beneficiary of that therapy, but generating the most appropriate beneficial cellular or tissue response in that specific situation, and optimising the clinically relevant performance of that therapy\".[9]\n\"Biocompatibility is the capability of a prosthesis implanted in the body to exist in harmony with tissue without causing deleterious changes\".[10]\nComments on the above five definitions \nThe Dorland Medical definition not recommended according to Williams Dictionary since it only defines biocompatibility as the absence of host response and does not include any desired or positive interactions between the host tissue and the biomaterials.\nThis is also called the \u201cWilliams definition\u201d or \u201cWilliam\u2019s definition\u201d.[11] It was defined in the European Society for Biomaterials Consensus Conference I and can more easily be found in \u2018The Williams Dictionary of Biomaterials\u2019.\nThe ASTM is not recommended according to Williams Dictionary since it only refers to local tissue responses, in animal models.\nThe fourth is an expansion or rather more precise version of the first definition noting both that low toxicity and the one should be aware of the different demands between various medical applications of the same material.\nThis section is empty. You can help by adding to it. (August 2014)\nAll these definitions deal with materials and not with devices. This is a drawback since many medical devices are made of more than one material. Much of the pre-clinical testing of the materials is not conducted on the devices but rather the material itself. But at some stage the testing will have to include the device since the shape, geometry and surface treatment etc. of the device will also affect its biocompatibility.\n\n \u2018Biocompatible\u2019 \nIn the literature, one quite often stumbles upon the adjective form, \u2018biocompatible\u2019. However, according to Williams\u2019 definition, this does not make any sense because biocompatibility is contextual, i.e. much more than just the material itself will determine the clinical outcome of the medical device of which the biomaterial is a part. This also points to one of the weaknesses with the current definition because a medical device usually is made of more than one material.\nMetallic glasses based on magnesium with zinc and calcium addition are tested as the potential biocompatible metallic biomaterials for biodegradable medical implants[12]\n\nSuggested sub-definitions \nThe scope of the first definition is so wide that D Williams tried to find suitable subgroups of applications in order to be able to make more narrow definitions. In the MDT article from 2003 the chosen supgroups and their definitions were:\n\nBiocompatibility of long-term implanted devices\nThe biocompatibility of a long-term implantable medical device refers to the ability of the device to perform its intended function, with the desired degree of incorporation in the host, without eliciting any undesirable local or systemic effects in that host.\nBiocompatibility of short-term implantable devices\nThe biocompatibility of a medical device that is intentionally placed within the cardiovascular system for transient diagnostic or therapeutic purposes refers to the ability of the device to carry out its intended function within flowing blood, with minimal interaction between device and blood that adversely affects device performance, and without inducing uncontrolled activation of cellular or plasma protein cascades.\nBiocompatibility of tissue-engineering products\nThe biocompatibility of a scaffold or matrix for a tissue-engineering products refers to the ability to perform as a substrate that will support the appropriate cellular activity, including the facilitation of molecular and mechanical signalling systems, in order to optimise tissue regeneration, without eliciting any undesirable effects in those cells, or inducing any undesirable local or systemic responses in the eventual host.\nIn these definitions the notion of biocompatibility is related to devices rather than to materials as compared to top three definitions. There was a consensus conference on biomaterial definitions in Sorrento September 15\u201316, 2005.[13]\n\nSee also \nBiocompatible material\nBiomaterial\nMedical device\nISO 10993\nMedical implant\nMedical grade silicone\nBovine submaxillary mucin coatings\nTitanium biocompatibility\nReferences \nFootnotes\n\n\n^ The more general definition could be adopted by the biomedical field.[6] \n\n\nNotes\n\n\n^ \"Biological Performance of Materials\", Jonathan Black,2006, ISBN 0-8493-3959-6 \n\n^ Considerations for the Biocompatibility Evaluation of Medical Devices, Kammula and Morris, Medical Device & Diagnostic Industry, May 2001 \n\n^ \u201cIn Vitro Biocompatibility Testing of Biomaterials and Medical Devices\u201d, U. Muller, Medical Device Technology, March 2008 \n\n^ \"Biocompatibility Safety Assessment of Medical Devices: FDA\/ISO and Japanese Guidelines\". Mddionline.com. Retrieved 20 November 2014 . \n\n^ Reshetov, I. V.; Starceva, O. I.; Istranov, A. L.; Vorona, B. N.; Lyundup, A. V.; Gulyaev, I. V.; Melnikov, D. V.; Shtansky, D. V.; Sheveyko, A. N. (2016). \"Three-dimensional biocompatible matrix for reconstructive surgery\". AIP Conference Proceedings. 1760 (1): 020056. doi:10.1063\/1.4960275. ISSN 0094-243X. \n\n^ a b c Vert, Michel (2012). \"Terminology for biorelated polymers and applications (IUPAC Recommendations 2012)\" (PDF) . Pure and Applied Chemistry. 84 (2): 377\u2013410. doi:10.1351\/PAC-REC-10-12-04. \n\n^ Dorland's Medical Dictionary \n\n^ The Williams dictionary of Biomaterials, D.F. Williams, 1999, ISBN 0-85323-921-5 \n\n^ Williams, David F. (2008). \"On the mechanisms of biocompatibility\". Biomaterials. 29: 2941\u20132953. doi:10.1016\/j.biomaterials.2008.04.023. \n\n^ International dictionary of medicine and biology, E. L. Becker, S. I. Landau, & A. Manuila, 1986, New York: Wiley. \n\n^ Williams, D (Oct 2003). \"Revisiting the definition of biocompatibility\". Medical device technology. 14 (8): 10\u20133. PMID 14603712. \n\n^ Nowosielski R., Cesarz-Andraczke K., Sakiewicz P., Maciej A., Jak\u00f3bik-Kolon A., Babilas R., Corrosion of biocompatible Mg66+XZn30-XCa4 (X=0.2) bulk metallic glasses, Arch. Metall. Mater. 2016 vol. 61 iss. 2, s. 807-810, \n\n^ [1] Archived February 6, 2005, at the Wayback Machine. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Biocompatibility\">https:\/\/www.limswiki.org\/index.php\/Biocompatibility<\/a>\n\t\t\t\t\tCategories: BiomaterialsScience termsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 29 February 2016, at 20:39.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 918 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","8242550c187fa50d6e13369341156e6c_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Biocompatibility skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Biocompatibility<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Biocompatibility<\/b> is related to the behavior of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterials\" class=\"mw-redirect\" title=\"Biomaterials\" rel=\"external_link\" target=\"_blank\">biomaterials<\/a> in various contexts. The term refers to the ability of a material to perform with an appropriate host response in a specific situation.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> The ambiguity of the term reflects the ongoing development of insights into how biomaterials interact with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_body\" title=\"Human body\" rel=\"external_link\" target=\"_blank\">human body<\/a> and eventually how those interactions determine the clinical success of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> (such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pacemaker\" class=\"mw-redirect\" title=\"Pacemaker\" rel=\"external_link\" target=\"_blank\">pacemaker<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">hip replacement<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stent<\/a>). Modern medical devices and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostheses\" class=\"mw-redirect\" title=\"Prostheses\" rel=\"external_link\" target=\"_blank\">prostheses<\/a> are often made of more than one material so it might not always be sufficient to talk about the biocompatibility of a specific material.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Since the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immune_response\" title=\"Immune response\" rel=\"external_link\" target=\"_blank\">immune response<\/a> and repair functions in the body are so complicated it is not adequate to describe the biocompatibility of a single material in relation to a single cell type or tissue. Sometimes one hears of biocompatibility testing that is a large battery of <a href=\"https:\/\/en.wikipedia.org\/wiki\/In_vitro\" title=\"In vitro\" rel=\"external_link\" target=\"_blank\">in vitro<\/a> test<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> that is used in accordance with <a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO_10993\" title=\"ISO 10993\" rel=\"external_link\" target=\"_blank\">ISO 10993<\/a> (or other similar standards) to determine if a certain material (or rather biomedical product) is biocompatible. These tests do not determine the biocompatibility of a material,<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> but they constitute an important step towards the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Animal_testing\" title=\"Animal testing\" rel=\"external_link\" target=\"_blank\">animal testing<\/a> and finally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_trial\" title=\"Clinical trial\" rel=\"external_link\" target=\"_blank\">clinical trials<\/a> that will determine the biocompatibility of the material in a given application, and thus <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical devices<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implants<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Drug_delivery_device\" class=\"mw-redirect\" title=\"Drug delivery device\" rel=\"external_link\" target=\"_blank\">drug delivery devices<\/a><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>.\n<\/p>\n<div class=\"quotebox pullquote floatright\" style=\";\">\n<div class=\"quotebox-title\" style=\"\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Union_of_Pure_and_Applied_Chemistry\" title=\"International Union of Pure and Applied Chemistry\" rel=\"external_link\" target=\"_blank\">IUPAC<\/a> definition<\/div>\n<div class=\"quotebox-quote left-aligned\" style=\"\"><b>Biocompatibility (biomedical therapy)<\/b>: Ability of a material to perform with an appropriate host response in a specific application.<sup id=\"rdp-ebb-cite_ref-IUPAC1_6-0\" class=\"reference\"><a href=\"#cite_note-IUPAC1-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[a]<\/a><\/sup><br \/>\n<b>Biocompatibility<\/b>: Ability to be in contact with a living system without producing an adverse effect.<sup id=\"rdp-ebb-cite_ref-IUPAC1_6-2\" class=\"reference\"><a href=\"#cite_note-IUPAC1-6\" rel=\"external_link\">[6]<\/a><\/sup><\/div>\n<\/div>\n<div class=\"floatright\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Annualpublbiocompatibility19702007.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Annualpublbiocompatibility19702007.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e2\/Annualpublbiocompatibility19702007.jpg\/220px-Annualpublbiocompatibility19702007.jpg\" width=\"220\" height=\"154\" \/><\/a><\/div>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The word <i>biocompatibility<\/i> seems to have been mentioned for the first time in peer-review journals and meetings in 1970 by RJ Hegyeli (Amer Chem Soc Annual Meeting abstract) and CA Homsy et al. (J Macromol Sci Chem A4:3,615, 1970). It took almost two decades before it began to be commonly used in scientific literature (see the graph below).\n<\/p><p>Recently Williams (again) has been trying to reevaluate the current knowledge status regarding what factors determine clinical success. Doing so notes that an implant may not always have to be positively bioactive but it must not do any harm (either locally or systemically) (Williams, 2008).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Five_definitions_of_biocompatibility\">Five definitions of biocompatibility<\/span><\/h2>\n<ol><li>\"The quality of not having <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxic\" class=\"mw-redirect\" title=\"Toxic\" rel=\"external_link\" target=\"_blank\">toxic<\/a> or injurious effects on biological systems\".<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[7]<\/a><\/sup><\/li>\n<li>\"The ability of a material to perform with an appropriate host response in a specific application\", Williams' definition.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[8]<\/a><\/sup><\/li>\n<li>\"Comparison of the tissue response produced through the close association of the implanted candidate material to its implant site within the host animal to that tissue response recognised and established as suitable with control materials\" - <a href=\"https:\/\/en.wikipedia.org\/wiki\/ASTM\" class=\"mw-redirect\" title=\"ASTM\" rel=\"external_link\" target=\"_blank\">ASTM<\/a><\/li>\n<li>\"Refers to the ability of a biomaterial to perform its desired function with respect to a medical therapy, without eliciting any undesirable local or systemic effects in the recipient or beneficiary of that therapy, but generating the most appropriate beneficial cellular or tissue response in that specific situation, and optimising the clinically relevant performance of that therapy\".<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li>\"Biocompatibility is the capability of a prosthesis implanted in the body to exist in harmony with tissue without causing deleterious changes\".<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[10]<\/a><\/sup><\/li><\/ol>\n<h2><span class=\"mw-headline\" id=\"Comments_on_the_above_five_definitions\">Comments on the above five definitions<\/span><\/h2>\n<ol><li>The Dorland Medical definition not recommended according to Williams Dictionary since it only defines biocompatibility as the absence of host response and does not include any desired or positive interactions between the host tissue and the biomaterials.<\/li>\n<li>This is also called the \u201cWilliams definition\u201d or \u201cWilliam\u2019s definition\u201d.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[11]<\/a><\/sup> It was defined in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/European_Society_for_Biomaterials\" title=\"European Society for Biomaterials\" rel=\"external_link\" target=\"_blank\">European Society for Biomaterials<\/a> Consensus Conference I and can more easily be found in \u2018The Williams Dictionary of Biomaterials\u2019.<\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/ASTM\" class=\"mw-redirect\" title=\"ASTM\" rel=\"external_link\" target=\"_blank\">ASTM<\/a> is not recommended according to Williams Dictionary since it only refers to local tissue responses, in animal models.<\/li>\n<li>The fourth is an expansion or rather more precise version of the first definition noting both that low toxicity and the one should be aware of the different demands between various medical applications of the same material.<\/li>\n<li><\/li><\/ol>\n<p>All these definitions deal with materials and not with devices. This is a drawback since many medical devices are made of more than one material. Much of the of the materials is not conducted on the devices but rather the material itself. But at some stage the testing will have to include the device since the shape, geometry and surface treatment etc. of the device will also affect its biocompatibility.\n<\/p>\n<h3><span id=\"rdp-ebb-.E2.80.98Biocompatible.E2.80.99\"><\/span><span class=\"mw-headline\" id=\"\u2018Biocompatible\u2019\">\u2018Biocompatible\u2019<\/span><\/h3>\n<p>In the literature, one quite often stumbles upon the adjective form, \u2018biocompatible\u2019. However, according to Williams\u2019 definition, this does not make any sense because biocompatibility is contextual, i.e. much more than just the material itself will determine the clinical outcome of the medical device of which the biomaterial is a part. This also points to one of the weaknesses with the current definition because a medical device usually is made of more than one material.\n<\/p><p>Metallic glasses based on magnesium with zinc and calcium addition are tested as the potential biocompatible metallic biomaterials for biodegradable medical implants<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Suggested_sub-definitions\">Suggested sub-definitions<\/span><\/h3>\n<p>The scope of the first definition is so wide that D Williams tried to find suitable subgroups of applications in order to be able to make more narrow definitions. In the MDT article from 2003 the chosen supgroups and their definitions were:\n<\/p>\n<dl><dt>Biocompatibility of long-term <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implanted devices<\/a><\/dt>\n<dd>The biocompatibility of a long-term implantable medical device refers to the ability of the device to perform its intended function, with the desired degree of incorporation in the host, without eliciting any undesirable local or systemic effects in that host.<\/dd><\/dl>\n<dl><dt>Biocompatibility of short-term implantable devices<\/dt>\n<dd>The biocompatibility of a medical device that is intentionally placed within the cardiovascular system for transient diagnostic or therapeutic purposes refers to the ability of the device to carry out its intended function within flowing blood, with minimal interaction between device and blood that adversely affects device performance, and without inducing uncontrolled activation of cellular or plasma protein cascades.<\/dd><\/dl>\n<dl><dt>Biocompatibility of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_engineering\" title=\"Tissue engineering\" rel=\"external_link\" target=\"_blank\">tissue-engineering<\/a> products<\/dt>\n<dd>The biocompatibility of a scaffold or matrix for a tissue-engineering products refers to the ability to perform as a substrate that will support the appropriate cellular activity, including the facilitation of molecular and mechanical signalling systems, in order to optimise tissue regeneration, without eliciting any undesirable effects in those cells, or inducing any undesirable local or systemic responses in the eventual host.<\/dd><\/dl>\n<p>In these definitions the notion of biocompatibility is related to devices rather than to materials as compared to top three definitions. There was a consensus conference on biomaterial definitions in Sorrento September 15\u201316, 2005.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatible_material\" class=\"mw-redirect\" title=\"Biocompatible material\" rel=\"external_link\" target=\"_blank\">Biocompatible material<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomaterial\" title=\"Biomaterial\" rel=\"external_link\" target=\"_blank\">Biomaterial<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">Medical device<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/ISO_10993\" title=\"ISO 10993\" rel=\"external_link\" target=\"_blank\">ISO 10993<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">Medical implant<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_grade_silicone\" title=\"Medical grade silicone\" rel=\"external_link\" target=\"_blank\">Medical grade silicone<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bovine_submaxillary_mucin_coatings\" title=\"Bovine submaxillary mucin coatings\" rel=\"external_link\" target=\"_blank\">Bovine submaxillary mucin coatings<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_biocompatibility\" title=\"Titanium biocompatibility\" rel=\"external_link\" target=\"_blank\">Titanium biocompatibility<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<dl><dt>Footnotes<\/dt><\/dl>\n<div class=\"reflist\" style=\"list-style-type: lower-alpha;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">The more general definition could be adopted by the biomedical field.<sup id=\"rdp-ebb-cite_ref-IUPAC1_6-1\" class=\"reference\"><a href=\"#cite_note-IUPAC1-6\" rel=\"external_link\">[6]<\/a><\/sup><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<dl><dt>Notes<\/dt><\/dl>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"Biological Performance of Materials\", Jonathan Black,2006, <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-8493-3959-6<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mddionline.com\/article\/considerations-biocompatibility-evaluation-medical-devices\" target=\"_blank\"><i>Considerations for the Biocompatibility Evaluation of Medical Devices<\/i><\/a>, Kammula and Morris, Medical Device & Diagnostic Industry, May 2001<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.emdt.co.uk\/article\/vitro-biocompatibility-testing-biomaterials-and-medical-devices\" target=\"_blank\">\u201cIn Vitro Biocompatibility Testing of Biomaterials and Medical Devices\u201d<\/a>, U. Muller, Medical Device Technology, March 2008<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mddionline.com\/article\/biocompatibility-safety-assessment-medical-devices-fdaiso-and-japanese-guidelines\" target=\"_blank\">\"Biocompatibility Safety Assessment of Medical Devices: FDA\/ISO and Japanese Guidelines\"<\/a>. Mddionline.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">20 November<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Biocompatibility+Safety+Assessment+of+Medical+Devices%3A+FDA%2FISO+and+Japanese+Guidelines&rft.pub=Mddionline.com&rft_id=http%3A%2F%2Fwww.mddionline.com%2Farticle%2Fbiocompatibility-safety-assessment-medical-devices-fdaiso-and-japanese-guidelines&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Reshetov, I. V.; Starceva, O. I.; Istranov, A. L.; Vorona, B. N.; Lyundup, A. V.; Gulyaev, I. V.; Melnikov, D. V.; Shtansky, D. V.; Sheveyko, A. N. (2016). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/aip.scitation.org\/doi\/abs\/10.1063\/1.4960275\" target=\"_blank\">\"Three-dimensional biocompatible matrix for reconstructive surgery\"<\/a>. <i>AIP Conference Proceedings<\/i>. <b>1760<\/b> (1): 020056. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1063%2F1.4960275\" target=\"_blank\">10.1063\/1.4960275<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0094-243X\" target=\"_blank\">0094-243X<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AIP+Conference+Proceedings&rft.atitle=Three-dimensional+biocompatible+matrix+for+reconstructive+surgery&rft.volume=1760&rft.issue=1&rft.pages=020056&rft.date=2016&rft_id=info%3Adoi%2F10.1063%2F1.4960275&rft.issn=0094-243X&rft.aulast=Reshetov&rft.aufirst=I.+V.&rft.au=Starceva%2C+O.+I.&rft.au=Istranov%2C+A.+L.&rft.au=Vorona%2C+B.+N.&rft.au=Lyundup%2C+A.+V.&rft.au=Gulyaev%2C+I.+V.&rft.au=Melnikov%2C+D.+V.&rft.au=Shtansky%2C+D.+V.&rft.au=Sheveyko%2C+A.+N.&rft_id=http%3A%2F%2Faip.scitation.org%2Fdoi%2Fabs%2F10.1063%2F1.4960275&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-IUPAC1-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-IUPAC1_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-IUPAC1_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-IUPAC1_6-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vert, Michel (2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pac.iupac.org\/publications\/pac\/pdf\/2012\/pdf\/8402x0377.pdf\" target=\"_blank\">\"Terminology for biorelated polymers and applications (IUPAC Recommendations 2012)\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pure_and_Applied_Chemistry\" title=\"Pure and Applied Chemistry\" rel=\"external_link\" target=\"_blank\">Pure and Applied Chemistry<\/a><\/i>. <b>84<\/b> (2): 377\u2013410. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1351%2FPAC-REC-10-12-04\" target=\"_blank\">10.1351\/PAC-REC-10-12-04<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pure+and+Applied+Chemistry&rft.atitle=Terminology+for+biorelated+polymers+and+applications+%28IUPAC+Recommendations+2012%29&rft.volume=84&rft.issue=2&rft.pages=377-410&rft.date=2012&rft_id=info%3Adoi%2F10.1351%2FPAC-REC-10-12-04&rft.aulast=Vert&rft.aufirst=Michel&rft_id=http%3A%2F%2Fpac.iupac.org%2Fpublications%2Fpac%2Fpdf%2F2012%2Fpdf%2F8402x0377.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dorland%27s_Medical_Dictionary\" class=\"mw-redirect\" title=\"Dorland's Medical Dictionary\" rel=\"external_link\" target=\"_blank\">Dorland's Medical Dictionary<\/a><\/i><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>The Williams dictionary of Biomaterials<\/i>, D.F. Williams, 1999, <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-85323-921-5<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Williams, David F. (2008). \"On the mechanisms of biocompatibility\". <i>Biomaterials<\/i>. <b>29<\/b>: 2941\u20132953. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.biomaterials.2008.04.023\" target=\"_blank\">10.1016\/j.biomaterials.2008.04.023<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biomaterials&rft.atitle=On+the+mechanisms+of+biocompatibility&rft.volume=29&rft.pages=2941-2953&rft.date=2008&rft_id=info%3Adoi%2F10.1016%2Fj.biomaterials.2008.04.023&rft.aulast=Williams&rft.aufirst=David+F.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>International dictionary of medicine and biology<\/i>, E. L. Becker, S. I. Landau, & A. Manuila, 1986, New York: Wiley.<\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Williams, D (Oct 2003). \"Revisiting the definition of biocompatibility\". <i>Medical device technology<\/i>. <b>14<\/b> (8): 10\u20133. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14603712\" target=\"_blank\">14603712<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Medical+device+technology&rft.atitle=Revisiting+the+definition+of+biocompatibility.&rft.volume=14&rft.issue=8&rft.pages=10-3&rft.date=2003-10&rft_id=info%3Apmid%2F14603712&rft.aulast=Williams&rft.aufirst=D&rfr_id=info%3Asid%2Fen.wikipedia.org%3ABiocompatibility\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Nowosielski R., Cesarz-Andraczke K., Sakiewicz P., Maciej A., Jak\u00f3bik-Kolon A., Babilas R., Corrosion of biocompatible Mg66+XZn30-XCa4 (X=0.2) bulk metallic glasses, Arch. Metall. Mater. 2016 vol. 61 iss. 2, s. 807-810,<\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.esb2005.it\/satellite.html\" target=\"_blank\">[1]<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20050206100618\/http:\/\/www.esb2005.it\/satellite.html\" target=\"_blank\">Archived<\/a> February 6, 2005, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1267\nCached time: 20181217080759\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.272 seconds\nReal time usage: 0.372 seconds\nPreprocessor visited node count: 1074\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 19860\/2097152 bytes\nTemplate argument size: 1224\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 22739\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.114\/10.000 seconds\nLua memory usage: 3.5 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 333.510 1 -total\n<\/p>\n<pre>66.42% 221.527 2 Template:Reflist\n19.65% 65.551 4 Template:Cite_journal\n19.17% 63.918 1 Template:Refimprove\n18.86% 62.899 2 Template:ISBN\n15.88% 52.948 1 Template:Cite_web\n13.25% 44.185 2 Template:Ambox\n11.87% 39.587 2 Template:Catalog_lookup_link\n 9.32% 31.070 1 Template:Quote_box\n 4.42% 14.725 1 Template:Notelist\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1665878-1!canonical and timestamp 20181217080759 and revision id 814240424\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214709\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.173 seconds\nReal time usage: 0.271 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 262.800 1 - wikipedia:Biocompatibility\n100.00% 262.800 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8184-0!*!*!*!*!*!* and timestamp 20181217214709 and revision id 24330\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Biocompatibility\">https:\/\/www.limswiki.org\/index.php\/Biocompatibility<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","8242550c187fa50d6e13369341156e6c_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/e\/e2\/Annualpublbiocompatibility19702007.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1c\/Wiki_letter_w_cropped.svg\/40px-Wiki_letter_w_cropped.svg.png"],"8242550c187fa50d6e13369341156e6c_timestamp":1545083229,"66f165c46927036533e0a0dd6571a8b1_type":"article","66f165c46927036533e0a0dd6571a8b1_title":"Assistive technology","66f165c46927036533e0a0dd6571a8b1_url":"https:\/\/www.limswiki.org\/index.php\/Assistive_technology","66f165c46927036533e0a0dd6571a8b1_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tAssistive technology\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\n\n Hearing aid\nAssistive technology is an umbrella term that includes assistive, adaptive, and rehabilitative devices for people with disabilities or elderly population while also including the process used in selecting, locating, and using them. People who have disabilities often have difficulty performing activities of daily living (ADLs) independently, or even with assistance. ADLs are self-care activities that include toileting, mobility (ambulation), eating, bathing, dressing and grooming. Assistive technology can ameliorate the effects of disabilities that limit the ability to perform ADLs. Assistive technology promotes greater independence by enabling people to perform tasks they were formerly unable to accomplish, or had great difficulty accomplishing, by providing enhancements to, or changing methods of interacting with, the technology needed to accomplish such tasks. For example, wheelchairs provide independent mobility for those who cannot walk, while assistive eating devices can enable people who cannot feed themselves to do so. Due to assistive technology, people with disabilities have an opportunity of a more positive and easygoing lifestyle, with an increase in \"social participation,\" \"security and control,\" and a greater chance to \"reduce institutional costs without significantly increasing household expenses.\"[1]\n\nContents \n\n1 Adaptive Technology \n2 Mobility impairments \n\n2.1 Wheelchairs \n2.2 Transfer devices \n2.3 Walkers \n2.4 Prosthesis \n\n\n3 Visual impairments \n\n3.1 Screen readers \n3.2 Braille and braille embossers \n3.3 Refreshable braille display \n3.4 Desktop video magnifier \n3.5 Screen magnification software \n3.6 Large-print and tactile keyboards \n3.7 Navigation Assistance \n3.8 Wearable Technology \n\n\n4 Personal emergency response systems \n5 Accessibility software \n6 Hearing impairments \n\n6.1 Hearing aids \n6.2 Assistive listening devices \n6.3 Amplified telephone equipment \n\n\n7 Augmentative and alternative communication \n8 Cognitive impairments \n\n8.1 Memory aids \n8.2 Educational software \n\n\n9 Eating Impairments \n10 In sports \n11 In education \n12 Computer accessibility \n13 Home automation \n14 Impacts \n15 See also \n16 References \n17 External links \n\n\nAdaptive Technology \nThe term adaptive technology is often used as the synonym for assistive technology; however, they are different terms. Assistive technology refers to \"any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities\",[2] while adaptive technology covers items that are specifically designed for persons with disabilities and would seldom be used by non-disabled persons. In other words, \"assistive technology is any object or system that increases or maintains the capabilities of people with disabilities,\" while adaptive technology is \"any object or system that is specifically designed for the purpose of increasing or maintaining the capabilities of people with disabilities.\"[3] Consequently, adaptive technology is a subset of assistive technology. Adaptive technology often refers specifically to electronic and information technology access.[4]\n\nMobility impairments \nWheelchairs \nMain article: Wheelchair\nWheelchairs are devices that can be manually propelled or electrically propelled, and that include a seating system and are designed to be a substitute for the normal mobility that most people have. Wheelchairs and other mobility devices allow people to perform mobility-related activities of daily living which include feeding, toileting, dressing, grooming, and bathing. The devices come in a number of variations where they can be propelled either by hand or by motors where the occupant uses electrical controls to manage motors and seating control actuators through a joystick, sip-and-puff control, or other input devices. Often there are handles behind the seat for someone else to do the pushing or input devices for caregivers. Wheelchairs are used by people for whom walking is difficult or impossible due to illness, injury, or disability. People with both sitting and walking disability often need to use a wheelchair or walker.\n\nTransfer devices \nMain article: Patient lift\nPatient transfer devices generally allow patients with impaired mobility to be moved by caregivers between beds, wheelchairs, commodes, toilets, chairs, stretchers, shower benches, automobiles, swimming pools, and other patient support systems (i.e., radiology, surgical, or examining tables). The most common devices are Patient lifts (for vertical transfer), Transfer benches, stretcher or convertible chairs (for lateral, supine transfer), sit-to-stand lifts (for moving patients from one seated position to another i.e., from wheelchairs to commodes), air bearing inflatable mattresses (for supine transfer i.e., transfer from a gurney to an operating room table), and sliding boards (usually used for transfer from a bed to a wheelchair). Highly dependent patients who cannot assist their caregiver in moving them often require a Patient lift (a floor or ceiling-suspended sling lift) which though invented in 1955 and in common use since the early 1960s is still considered the state-of-the-art transfer device by OSHA and the American Nursing Association.\n\nWalkers \nMain article: WalkerA walker or walking frame or Rollator is a tool for disabled people who need additional support to maintain balance or stability while walking. It consists of a frame that is about waist high, approximately twelve inches deep and slightly wider than the user. Walkers are also available in other sizes, such as for children, or for heavy people. Modern walkers are height-adjustable. The front two legs of the walker may or may not have wheels attached depending on the strength and abilities of the person using it. It is also common to see caster wheels or glides on the back legs of a walker with wheels on the front.[5]\nProsthesis \nMain article: ProsthesisA prosthesis, prosthetic, or prosthetic limb is a device that replaces a missing body part. It is part of the field of biomechatronics, the science of using mechanical devices with human muscle, skeleton, and nervous systems to assist or enhance motor control lost by trauma, disease, or defect. Prostheses are typically used to replace parts lost by injury (traumatic) or missing from birth (congenital) or to supplement defective body parts. Inside the body, artificial heart valves are in common use with artificial hearts and lungs seeing less common use but under active technology development. Other medical devices and aids that can be considered prosthetics include hearing aids, artificial eyes, palatal obturator, gastric bands, and dentures.\nProstheses are specifically not orthoses, although given certain circumstances a prosthesis might end up performing some or all of the same functionary benefits as an orthosis. Prostheses are technically the complete finished item. For instance, a C-Leg knee alone is not a prosthesis, but only a prosthetic component. The complete prosthesis would consist of the attachment system  to the residual limb \u2014 usually a \"socket\", and all the attachment hardware components all the way down to and including the terminal device. Keep this in mind as nomenclature is often interchanged.\nThe terms \"prosthetic\" and \"orthotic\" are adjectives used to describe devices such as a prosthetic knee. The terms \"prosthetics\" and \"orthotics\" are used to describe the respective allied health fields.\n\nVisual impairments \nMain article: Blindness \u00a7 Management\nMany people with serious visual impairments live independently, using a wide range of tools and techniques. Examples of assistive technology for visually impairment include screen readers, screen magnifiers, Braille embossers, desktop video magnifiers, and voice recorders.\n\nScreen readers \nMain article: Screen reader\nScreen readers are used to help the visually impaired to easily access electronic information. These software programs run on a computer in order to convey the displayed information through voice (text-to-speech) or braille (refreshable braille displays) in combination with magnification for low vision users in some cases. There are a variety of platforms and applications available for a variety of costs with differing feature sets.\nOne example of screen readers is Apple VoiceOver. This software is provided free of charge on all Apple devices. Apple VoiceOver includes the option to magnify the screen, control the keyboard, and provide verbal descriptions to describe what is happening on the screen. There are thirty languages to select from. It also has the capacity to read aloud file content, as well as web pages, E-mail messages, and word processing files.\n\n Braille is a system of raised dots representing letters, numbers, punctuation, and words.\nBraille and braille embossers \nMain article: Braille\nBraille is a system of raised dots formed into units called braille cells. A full braille cell is made up of six dots, with two parallel rows of three dots, but other combinations and quantities of dots represent other letters, numbers, punctuation marks, or words. People can then use their fingers to read the code of raised dots.\nA braille embosser is, simply put, a printer for braille. Instead of a standard printer adding ink onto a page, the braille embosser imprints the raised dots of braille onto a page. Some braille embossers combine both braille and ink so the documents can be read with either sight or touch.\n\nRefreshable braille display \nMain article: Refreshable braille display\nA refreshable braille display or braille terminal is an electro-mechanical device for displaying braille characters, usually by means of round-tipped pins raised through holes in a flat surface. Computer users who cannot use a computer monitor use it to read a braille output version of the displayed text.\n\nDesktop video magnifier \nMain article: Video magnifier\nDesktop video magnifiers are electronic devices that use a camera and a display screen to perform digital magnification of printed materials. They enlarge printed pages for those with low vision. A camera connects to a monitor that displays real-time images, and the user can control settings such as magnification, focus, contrast, underlining, highlighting, and other screen preferences. They come in a variety of sizes and styles; some are small and portable with handheld cameras, while others are much larger and mounted on a fixed stand.\n\nScreen magnification software \nMain article: Screen magnifier\nA screen magnifier is software that interfaces with a computer's graphical output to present enlarged screen content. It allows users to enlarge the texts and graphics on their computer screens for easier viewing. Similar to desktop video magnifiers, this technology assists people with low vision. After the user loads the software into their computer's memory, it serves as a kind of \"computer magnifying glass.\" Wherever the computer cursor moves, it enlarges the area around it. This allows greater computer accessibility for a wide range of visual abilities.\n\n This large-print keyboard has tactile elements and special keys for the visually impaired\nLarge-print and tactile keyboards \nA large-print keyboard has large letters printed on the keys. On the keyboard shown, the round buttons at the top control software which can magnify the screen (zoom in), change the background color of the screen, or make the mouse cursor on the screen larger. The \"bump dots\" on the keys, installed in this case by the organization using the keyboards, help the user find the right keys in a tactile way.\n\nNavigation Assistance \nAssistive technology for navigation has exploded on the IEEE Xplore database since 2000, with over 7,500 engineering articles written on assistive technologies and visual impairment in the past 25 years, and over 1,300 articles on solving the problem of navigation for people who are blind or visually impaired. As well, over 600 articles on augmented reality and visual impairment have appeared in the engineering literature since 2000. Most of these articles were published within the past 5 years, and the number of articles in this area is increasing every year. GPS, accelerometers, gyroscopes, and cameras can pinpoint the exact location of the user and provide information on what's in the immediate vicinity, and assistance in getting to a destination.\n\nWearable Technology \nMain article: Wearable technology\nWearable technology are smart electronic devices that can be worn on the body as an implant or an accessory. New technologies are exploring how the visually impaired can receive visual information through wearable devices.[6]\nSome wearable devices for visual impairment include:\n\neSight\nBrainport\nPersonal emergency response systems \nMain article: Telecare\n This voter with a manual dexterity disability is making choices on a touchscreen with a head dauber\nPersonal emergency response systems (PERS), or Telecare (UK term), are a particular sort of assistive technology that use electronic sensors connected to an alarm system to help caregivers manage risk and help vulnerable people stay independent at home longer. An example would be the systems being put in place for senior people such as fall detectors, thermometers (for hypothermia risk), flooding and unlit gas sensors (for people with mild dementia). Notably, these alerts can be customized to the particular person's risks. When the alert is triggered, a message is sent to a caregiver or contact center who can respond appropriately.\n\nAccessibility software \nMain article: Computer accessibility\nIn human\u2013computer interaction, computer accessibility (also known as accessible computing) refers to the accessibility of a computer system to all people, regardless of disability or severity of impairment, examples include web accessibility guidelines.[7] Another approach is for the user to present a token to the computer terminal, such as a smart card, that has configuration information to adjust the computer speed, text size, etc. to their particular needs. This is useful where users want to access public computer based terminals in Libraries, ATM, Information kiosks etc. The concept is encompassed by the CEN EN 1332-4 Identification Card Systems - Man-Machine Interface.[8] This development of this standard has been supported in Europe by SNAPI and has been successfully incorporated into the Lasseo specifications, but with limited success due to the lack of interest from public computer terminal suppliers.\n\nHearing impairments \nMain article: Assistive Technology for Deaf and Hard of Hearing\nPeople in the d\/Deaf and hard of hearing community have a more difficult time receiving auditory information as compared to hearing individuals. These individuals often rely on visual and tactile mediums for receiving and communicating information. The use of assistive technology and devices provides this community with various solutions to auditory communication needs by providing higher sound (for those who are hard of hearing), tactile feedback, visual cues and improved technology access. Individuals who are deaf or hard of hearing utilize a variety of assistive technologies that provide them with different access to information in numerous environments.[9] Most devices either provide amplified sound or alternate ways to access information through vision and\/or vibration. These technologies can be grouped into three general categories: Hearing Technology, alerting devices, and communication support.\n\nHearing aids \nMain article: Hearing aid\nA hearing aid or deaf aid is an electroacoustic device which is designed to amplify sound for the wearer, usually with the aim of making speech more intelligible, and to correct impaired hearing as measured by audiometry. This type of assistive technology helps people with hearing loss participate more fully in their hearing communities by allowing them to hear more clearly. They amplify any and all sound waves through use of a microphone, amplifier, and speaker. There is a wide variety of hearing aids available, including digital, in-the-ear, in-the-canal, behind-the-ear, and on-the-body aids.\n\nAssistive listening devices \nMain article: Assistive listening device\nAssistive listening devices include FM, infrared, and loop assistive listening devices. This type of technology allows people with hearing difficulties to focus on a speaker or subject by getting rid of extra background noises and distractions, making places like auditoriums, classrooms, and meetings much easier to participate in. The assistive listening device usually uses a microphone to capture an audio source near to its origin and broadcast it wirelessly over an FM (Frequency Modulation) transmission, IR (Infra Red) transmission, IL (Induction Loop) transmission, or other transmission methods. The person who is listening may use an FM\/IR\/IL Receiver to tune into the signal and listen at his\/her preferred volume.\n\nAmplified telephone equipment \nMain article: Telecommunications device for the deaf#Other devices for the deaf or hard of hearing\nThis type of assistive technology allows users to amplify the volume and clarity of their phone calls so that they can easily partake in this medium of communication. There are also options to adjust the frequency and tone of a call to suit their individual hearing needs. Additionally, there is a wide variety of amplified telephones to choose from, with different degrees of amplification. For example, a phone with 26 to 40 decibel is generally sufficient for mild hearing loss, while a phone with 71 to 90 decibel is better for more severe hearing loss.[10]\n\nAugmentative and alternative communication \nMain article: Augmentative and alternative communication\n An AAC user uses number coding on an eye gaze communication board\nAugmentative and alternative communication (AAC) is an umbrella term that encompasses methods of communication for those with impairments or restrictions on the production or comprehension of spoken or written language.[11] AAC systems are extremely diverse and depend on the capabilities of the user. They may be as basic as pictures on a board that are used to request food, drink, or other care; or they can be advanced speech generating devices, based on speech synthesis, that are capable of storing hundreds of phrases and words.[12]\n\nCognitive impairments \nMain article: Cognitive orthotics\nAssistive Technology for Cognition (ATC)[13] is the use of technology (usually high tech) to augment and assist cognitive processes such as attention, memory, self-regulation, navigation, emotion recognition and management, planning, and sequencing activity. Systematic reviews of the field have found that the number of ATC are growing rapidly, but have focused on memory and planning, that there is emerging evidence for efficacy, that a lot of scope exists to develop new ATC.[14] Examples of ATC include: NeuroPage which prompts users about meetings,[15] Wakamaru, which provides companionship and reminds users to take medicine and calls for help if something is wrong, and telephone Reassurance systems.[16]\n\nMemory aids \nMemory aids are any type of assistive technology that helps a user learn and remember certain information. Many memory aids are used for cognitive impairments such as reading, writing, or organizational difficulties. For example, a Smartpen records handwritten notes by creating both a digital copy and an audio recording of the text. Users simply tap certain parts of their notes, the pen saves it, and reads it back to them. From there, the user can also download their notes onto a computer for increased accessibility. Digital voice recorders are also used to record \"in the moment\" information for fast and easy recall at a later time.[17]\n\nEducational software \nMain article: Educational software\nEducational software is software that assists people with reading, learning, comprehension, and organizational difficulties. Any accommodation software such as text readers, notetakers, text enlargers, organization tools, word predictions, and talking word processors falls under the category of educational software.\n\nEating Impairments \nMain article: Assistive eating devices\nAdaptive eating devices include items commonly used by the general population like spoons and forks and plates. However they become assistive technology when they are modified to accommodate the needs of people who have difficultly using standard cutlery due to a disabling condition. Common modifications include increasing the size of the utensil handle to make it easier to grasp. Plates and bowls may have a guard on the edge that stops food being pushed off of the dish when it is being scooped. More sophisticated equipment for eating includes manual and powered feeding devices. These devices support those who have little or no hand and arm function and enable them to eat independently.\n\nIn sports \n A New York City Marathon competitor uses a racing wheelchair\nAssistive technology in sports is an area of technology design that is growing. Assistive technology is the array of new devices created to enable sports enthusiasts who have disabilities to play. Assistive technology may be used in adaptive sports, where an existing sport is modified to enable players with a disability to participate; or, assistive technology may be used to invent completely new sports with athletes with disabilities exclusively in mind.\nAn increasing number of people with disabilities are participating in sports, leading to the development of new assistive technology.[18] Assistive technology devices can be simple, or \"low-tech\", or they may use highly advanced technology. \"Low-tech\" devices can include velcro gloves and adaptive bands and tubes. \"High-tech\" devices can include all-terrain wheelchairs and adaptive bicycles.[19] Accordingly, assistive technology can be found in sports ranging from local community recreation to the elite Paralympic Games. More complex assistive technology devices have been developed over time, and as a result, sports for people with disabilities \"have changed from being a clinical therapeutic tool to an increasingly competition-oriented activity\".[20]\n\nIn education \nIn the United States there are two major pieces of legislation that govern the use of assistive technology within the school system. The first is Section 504 of the Rehabilitation Act of 1973 and the second being the Individuals with Disabilities Education Act (IDEA) which was first enacted in 1975 under the name The Education for All Handicapped Children Act. In 2004, during the reauthorization period for IDEA, the National Instructional Material Access Center (NIMAC) was created which provided a repository of accessible text including publisher's textbooks to students with a qualifying disability. Files provided are in XML format and used as a starting platform for braille readers, screen readers, and other digital text software.[21] IDEA defines assistive technology as follows: \"any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability. (B) Exception.--The term does not include a medical device that is surgically implanted, or the replacement of such device.\"[22]\nAssistive technology in this area is broken down into low, mid, and high tech categories. Low tech encompasses equipment that is often low cost and does not include batteries or requires charging. Examples include adapted paper and pencil grips for writing or masks and color overlays for reading. Mid tech supports used in the school setting include the use of handheld spelling dictionaries and portable word processors used to keyboard writing. High tech supports involve the use of tablet devices and computers with accompanying software. Software supports for writing include the use of auditory feedback while keyboarding, word prediction for spelling, and speech to text. Supports for reading include the use of text to speech (TTS) software and font modification via access to digital text. Limited supports are available for math instruction and mostly consist of grid based software to allow younger students to keyboard equations and auditory feedback of more complex equations using MathML and Daisy.\n\nComputer accessibility \nMain article: Computer accessibility\n A sip-and-puff device which allows a person with substantial disability to make selections and navigate computerized interfaces by controlling inhalations and exhalations\nOne of the largest problems that affect people with disabilities is discomfort with prostheses.[23] An experiment performed in Massachusetts utilized 20 people with various sensors attached to their arms.[23] The subjects tried different arm exercises, and the sensors recorded their movements. All of the data helped engineers develop new engineering concepts for prosthetics.[23]\nAssistive technology may attempt to improve the ergonomics of the devices themselves such as Dvorak and other alternative keyboard layouts, which offer more ergonomic layouts of the keys.[24][25]\nAssistive technology devices have been created to enable people with disabilities to use modern touch screen mobile computers such as the iPad, iPhone and iPod touch. The Pererro is a plug and play adapter for iOS devices which uses the built in Apple VoiceOver feature in combination with a basic switch. This brings touch screen technology to those who were previously unable to use it. Apple, with the release of iOS 7 had introduced the ability to navigate apps using switch control. Switch access could be activated either through an external bluetooth connected switch, single touch of the screen, or use of right and left head turns using the device's camera. Additional accessibility features include the use of Assistive Touch which allows a user to access multi-touch gestures through pre-programmed onscreen buttons.\n\n<\/p>For users with physical disabilities a large variety of switches are available and customizable to the user's needs varying in size, shape, or amount of pressure required for activation. Switch access may be placed near any area of the body which has consistent and reliable mobility and less subject to fatigue. Common sites include the hands, head, and feet. Eye gaze and head mouse systems can also be used as an alternative mouse navigation. A user may utilize single or multiple switch sites and the process often involves a scanning through items on a screen and activating the switch once the desired object is highlighted.\n\nHome automation \nThe form of home automation called assistive domotics focuses on making it possible for elderly and disabled people to live independently. Home automation is becoming a viable option for the elderly and disabled who would prefer to stay in their own homes rather than move to a healthcare facility. This field uses much of the same technology and equipment as home automation for security, entertainment, and energy conservation but tailors it towards elderly and disabled users. For example, automated prompts and reminders utilize motion sensors and pre-recorded audio messages; an automated prompt in the kitchen may remind the resident to turn off the oven, and one by the front door may remind the resident to lock the door.[26]\n\nImpacts \nOverall, assistive technology aims to allow people with disabilities to \"participate more fully in all aspects of life (home, school, and community)\" and increases their opportunities for \"education, social interactions, and potential for meaningful employment\".[27] It creates greater independence and control for disabled individuals. For example, in one study of 1,342 infants, toddlers and preschoolers, all with some kind of developmental, physical, sensory, or cognitive disability, the use of assistive technology created improvements in child development.[28] These included improvements in \"cognitive, social, communication, literacy, motor, adaptive, and increases in engagement in learning activities\".[29] Additionally, it has been found to lighten caregiver load.[30] Both family and professional caregivers benefit from assistive technology. Through its use, the time that a family member or friend would need to care for a patient significantly decreases. However, studies show that care time for a professional caregiver increases when assistive technology is used. Nonetheless, their work load is significantly easier as the assistive technology frees them of having to perform certain tasks.[31] There are several platforms that use machine learning to identify the appropriate assistive device to suggest to patients, making assistive devices more accessible.[32]\n\nSee also \n\n\n\nWikimedia Commons has media related to Assistive technology.\n\nAccessibility\nAssisted Living\nAssistive Living\nAugmentative and alternative communication\nBraille technology\nDesign for All (in ICT)\nDurable medical equipment\nMatching Person & Technology Model\nOATS: Open Source Assistive Technology Software\nOccupational Therapy\nTransgenerational design\nUniversal access to education\n\nReferences \nSource\nAmerican Speech-Language-Hearing Association. (2005). \"Roles and Responsibilities of Speech-Language Pathologists With Respect to Augmentative and Alternative Communication: Position Statement\". Archived from the original on February 13, 2009. Retrieved January 23, 2009 . \nDeCoste, Denise C. (1997). \"Chapter 10: Introduction to Augmentative and Alternative Communication Systems\". In Glennen, Sharon; DeCoste, Denise C. Handbook Of Augmentative And Alternative Communication. San Diego, CA: Singular Publishing Group. ISBN 1-56593-684-1. \nSchlosser, R. W.; Wendt, O. (2008). \"Effects of augmentative and alternative communication intervention on speech production in children with autism: a systematic review\". American Journal of Speech-Language Pathology. 17 (3): 212\u2013230. doi:10.1044\/1058-0360(2008\/021). PMID 18663107. \nBeukelman, David R.; Mirenda, Pat (2005). Augmentative & alternative communication: supporting children & adults with complex communication needs (3rd ed.). Paul H. Brookes Publishing Company. ISBN 978-1-55766-684-0. \nGalv\u00e3o Filho, T. (2009). \"Tecnologia Assistiva para uma Escola Inclusiva: apropria\u00e7\u00e3o, demandas e perspectivas. Tese (Doutorado em Educa\u00e7\u00e3o) \u2013 Faculdade de Educa\u00e7\u00e3o, Universidade Federal da Bahia, Salvador, Brazil\". \nMirenda, P. (2003). \"Toward Functional Augmentative and Alternative Communication for Students With Autism: Manual Signs, Graphic Symbols, and Voice Output Communication Aids\". Language, Speech, & Hearing Services in Schools. 34 (3): 203\u2013216. doi:10.1044\/0161-1461(2003\/017). \nMathy; Yorkston, K.; Guttman (2000). \"Augmentative Communication for Individuals with Amyotrophic Lateral Sclerosis\". In Beukelman, D.; Yorkston, K.; Reichle, J. Augmentative and Alternative Communication Disorders for Adults with Acquired Neurologic Disorders. Baltimore: P. H. Brookes Pub. ISBN 978-1-55766-473-0. \nJans, Deborah; Clark, Sue (1998). \"Chapter 6: High Technology Aids to Communication\". In Wilson, Allan. Augmentative Communication in Practice: An Introduction. University of Edinburgh. ISBN 978-1-898042-15-0. \nParette, H. P.; Brotherson, M. J; Huer, M. B. (2000). \"Giving families a voice in augmentative and alternative communication decision-making\". Education and Training in Mental Retardation and Developmental Disabilities. 35: 177\u2013190. \nNotes\n\n\n^ Parant, Aymeric; Schiano-Lomoriello, Sandrine; Marchan, Francis (October 2017). \"How would I live with a disability? Expectations of bio-psychosocial consequences and assistive technology use\". Disability and Rehabilitation. Assistive Technology. 12 (7): 681\u2013685. doi:10.1080\/17483107.2016.1218555. ISSN 1748-3115. PMID 27677931. \n\n^ \"Assistive Technology Act of 1998 | Section508.gov\". section508.gov. Retrieved 2016-04-04 . \n\n^ \"Tennessee Science Standards\" (PDF) . Retrieved 2012-10-05 . \n\n^ \"Assessing for Adaptive Technology Needs\". Retrieved 2012-10-05 . \n\n^ C. Barru\u00e9. Personalization and Shared Autonomy in Assistive Technologies. Ph. Thesis. Universitat Polit\u00e8cnica de Catalunya. 2012 \n\n^ Pardes, Arielle. \"The Wearables Giving Computer Vision to the Blind\". Wired. Wired. Retrieved 5 September 2017 . \n\n^ Web accessibility guidelines \n\n^ CEN EN 1332-4 Identification Card Systems - Man-Machine Interface \n\n^ \"Assistive Technology for Individuals who are Deaf or Hard of Hearing\" (PDF) . Retrieved 2015-11-08 . \n\n^ \"Guide to Amplified Phones\". assistech.com. Retrieved 2015-11-25 . \n\n^ ASHA (2005). \n\n^ Gilliam & Marquardt, pp. 356\u2013359. \n\n^ LoPresti, E.F., Mihailidis, A. & Kirsch, N. (2004). Assistive Technology for cognitive rehabilitation: State of the art. Neuropsychological Rehabilitation, 14, 5-39. \n\n^ Gillespie, A., Best, C. & O'Neill, B. (2012). Cognitive function and Assistive Technology for cognition: A systematic review. Journal of the International Neuropsychological Society, 18, 1-19. \n\n^ Wilson, et al. (1997). Evaluation of NeuroPage: A new memory aid. Journal of Neurology, Neurosurgery, and Psychiatry, 63, 113-115. \n\n^ assistivetech.net: Telephone Reassurance. Accessed 2009-08-06. \n\n^ \"Using External Aids to Compensate for Memory and Organizational Problems Post-TBI\". Retrieved 2015-11-30 . \n\n^ Scherer, Marcia; Stefano Federici (2012). Assistive Technology Assessment Handbook. CRC Press. p. 425. ISBN 9781439838655. \n\n^ \"Assistive technologies\". Spaulding Framingham. Retrieved September 5, 2012 . \n\n^ Scherer, Marcia; Stefano Federici (2012). Assistive Technology Assessment Handbook. CRC Press. p. 427. ISBN 9781439838655. \n\n^ \"National Instructional Materials Access Center\". \n\n^ \"Building the Legacy: IDEA 2004\". \n\n^ a b c Abdullah, Hussein A.; Tarry, Cole; Datta, Rahul.; Mittal, Gauri S.; Abderrahim, Mohamed (2007). \"Dynamic Biomechanical Model for Assessing and Monitoring Robot-Assisted Upper-Limb Therapy\". Journal of Rehabilitation Research and Development. 44 (1): 43\u201362. doi:10.1682\/JRRD.2006.03.0025. PMID 17551857. \n\n^ Chubon, R.A.; Hester, M.R. (1988). \"An enhanced standard computer keyboard system for single-finger and typing-stick typing\". Journal of Rehabilitation Research and Development. 25 (4): 17\u201324. PMID 2973523. \n\n^ Anson, D.; George, S.; Galup, R.; Shea, B.; Vetter, R. (2001). \"Efficiency of the Chubon versus the QWERTY keyboard\". Assistive-Technology. 13 (1): 40\u20135. doi:10.1080\/10400435.2001.10132032. PMID 12212435. \n\n^ Judd, Natasha. \"Assistive technology - devices to help with everyday living\". www.alzheimers.org.uk. Retrieved 2015-11-30 . \n\n^ \"Considering Assistive Technology | Center for Parent Information and Resources\". www.parentcenterhub.org. Retrieved 2015-11-25 . \n\n^ Desch, Larry W.; Gaebler-Spira, Deborah (2008-06-01). \"Prescribing Assistive-Technology Systems: Focus on Children With Impaired Communication\". Pediatrics. 121 (6): 1271\u20131280. doi:10.1542\/peds.2008-0695. ISSN 0031-4005. PMID 18519500. \n\n^ Dunst, Trivette; Hamby, Simkus (August 2013). \"Research Summary on Assistive Technology Interventions\" (PDF) . Community. Retrieved 24 November 2015 . \n\n^ Nicolson, Amy; Moir, Lois; Millsteed, Jeannine (22 March 2012). \"Impact of assistive technology on family caregivers of children with physical disabilities: a systematic review\". Disability and Rehabilitation: Assistive Technology. 7 (5): 345\u2013349. doi:10.3109\/17483107.2012.667194. \n\n^ Anderson, Wayne L.; Wiener, Joshua M. (2015-06-01). \"The Impact of Assistive Technologies on Formal and Informal Home Care\". The Gerontologist. 55 (3): 422\u2013433. doi:10.1093\/geront\/gnt165. ISSN 0016-9013. \n\n^ https:\/\/www.atvisor.ai\/ \n\n\nExternal links \nvteDisabilityMain topics\nDisability\nDisability studies\nMedical model\nSocial model\nSociety for Disability Studies\nApproaches\nFreak show\nIEP\nInclusion\nLearning disability\nMainstreaming\nPhysical therapy\ndriver rehabilitation\nSpecial needs\nschool\neducation\nRights, Law, SupportRights\nAbleism\/Disablism\nDisability rights\nPejorative terms\nLaw\nAODA\nADA\nConvention on the Rights of Persons with Disabilities\nDeclaration on the Rights of Disabled Persons\nInternational Classification of Functioning, Disability and Health\nServices\nServices for mental disorders\nServices for the disabled\nSupport\nDLA\nODSP\nRail\nSSDI\nSSI\nStudents\nCNIB\nActivist groups\nCCD\nDPI\nMINDS\nReach Canada\nVisitability\nStructural and assistive\nActivities of daily living\nAssistive technology\nIndependent living\nMobility aid\nOrthotics and braces\nPersonal Care Assistant\nPhysical accessibility\nProsthetics\nUniversal 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","66f165c46927036533e0a0dd6571a8b1_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Assistive_technology skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Assistive technology<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p class=\"mw-empty-elt\">\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hoergeraet_analog_050609.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c0\/Hoergeraet_analog_050609.jpg\/220px-Hoergeraet_analog_050609.jpg\" width=\"220\" height=\"141\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hoergeraet_analog_050609.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Hearing aid<\/div><\/div><\/div>\n<p><b>Assistive technology<\/b> is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Umbrella_term\" title=\"Umbrella term\" rel=\"external_link\" target=\"_blank\">umbrella term<\/a> that includes assistive, adaptive, and rehabilitative devices for <a href=\"https:\/\/en.wikipedia.org\/wiki\/People_with_disabilities\" class=\"mw-redirect\" title=\"People with disabilities\" rel=\"external_link\" target=\"_blank\">people with disabilities<\/a> or elderly population while also including the process used in selecting, locating, and using them. People who have disabilities often have difficulty performing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Activities_of_daily_living\" title=\"Activities of daily living\" rel=\"external_link\" target=\"_blank\">activities of daily living<\/a> (ADLs) independently, or even with assistance. ADLs are self-care activities that include toileting, mobility (ambulation), eating, bathing, dressing and grooming. Assistive technology can ameliorate the effects of disabilities that limit the ability to perform ADLs. Assistive technology promotes greater independence by enabling people to perform tasks they were formerly unable to accomplish, or had great difficulty accomplishing, by providing enhancements to, or changing methods of interacting with, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Technology\" title=\"Technology\" rel=\"external_link\" target=\"_blank\">technology<\/a> needed to accomplish such tasks. For example, wheelchairs provide independent mobility for those who cannot walk, while <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_eating_devices\" title=\"Assistive eating devices\" rel=\"external_link\" target=\"_blank\">assistive eating devices<\/a> can enable people who cannot feed themselves to do so. Due to assistive technology, people with disabilities have an opportunity of a more positive and easygoing lifestyle, with an increase in \"social participation,\" \"security and control,\" and a greater chance to \"reduce institutional costs without significantly increasing household expenses.\"<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Adaptive_Technology\">Adaptive Technology<\/span><\/h2>\n<p>The term adaptive technology is often used as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Synonym\" title=\"Synonym\" rel=\"external_link\" target=\"_blank\">synonym<\/a> for assistive technology; however, they are different terms. Assistive technology refers to \"any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities\",<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> while adaptive technology covers items that are specifically designed for persons with disabilities and would seldom be used by non-disabled persons. In other words, \"assistive technology is any object or system that increases or maintains the capabilities of people with disabilities,\" while adaptive technology is \"any object or system that is specifically designed for the purpose of increasing or maintaining the capabilities of people with disabilities.\"<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> Consequently, adaptive technology is a subset of assistive technology. Adaptive technology often refers specifically to electronic and information technology access.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Mobility_impairments\">Mobility impairments<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Wheelchairs\">Wheelchairs<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wheelchair\" title=\"Wheelchair\" rel=\"external_link\" target=\"_blank\">Wheelchair<\/a><\/div>\n<p>Wheelchairs are devices that can be manually propelled or electrically propelled, and that include a seating system and are designed to be a substitute for the normal mobility that most people have. Wheelchairs and other mobility devices allow people to perform mobility-related <a href=\"https:\/\/en.wikipedia.org\/wiki\/Activities_of_daily_living\" title=\"Activities of daily living\" rel=\"external_link\" target=\"_blank\">activities of daily living<\/a> which include feeding, toileting, dressing, grooming, and bathing. The devices come in a number of variations where they can be propelled either by hand or by motors where the occupant uses electrical controls to manage motors and seating control actuators through a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joystick\" title=\"Joystick\" rel=\"external_link\" target=\"_blank\">joystick<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sip-and-puff\" title=\"Sip-and-puff\" rel=\"external_link\" target=\"_blank\">sip-and-puff<\/a> control, or other input devices. Often there are handles behind the seat for someone else to do the pushing or input devices for caregivers. Wheelchairs are used by people for whom <a href=\"https:\/\/en.wikipedia.org\/wiki\/Walking\" title=\"Walking\" rel=\"external_link\" target=\"_blank\">walking<\/a> is difficult or impossible due to illness, injury, or disability. People with both sitting and walking disability often need to use a wheelchair or walker.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Transfer_devices\">Transfer devices<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_lift\" title=\"Patient lift\" rel=\"external_link\" target=\"_blank\">Patient lift<\/a><\/div>\n<p>Patient transfer devices generally allow patients with impaired mobility to be moved by caregivers between beds, wheelchairs, commodes, toilets, chairs, stretchers, shower benches, automobiles, swimming pools, and other patient support systems (i.e., radiology, surgical, or examining tables). The most common devices are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_lift\" title=\"Patient lift\" rel=\"external_link\" target=\"_blank\">Patient lifts<\/a> (for vertical transfer), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transfer_bench\" title=\"Transfer bench\" rel=\"external_link\" target=\"_blank\">Transfer benches<\/a>, stretcher or convertible chairs (for lateral, supine transfer), sit-to-stand lifts (for moving patients from one seated position to another i.e., from wheelchairs to commodes), air bearing inflatable mattresses (for supine transfer i.e., transfer from a gurney to an operating room table), and sliding boards (usually used for transfer from a bed to a wheelchair). Highly dependent patients who cannot assist their caregiver in moving them often require a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_lift\" title=\"Patient lift\" rel=\"external_link\" target=\"_blank\">Patient lift<\/a> (a floor or ceiling-suspended sling lift) which though invented in 1955 and in common use since the early 1960s is still considered the state-of-the-art transfer device by OSHA and the American Nursing Association.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Walkers\">Walkers<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Walker_(mobility)\" title=\"Walker (mobility)\" rel=\"external_link\" target=\"_blank\">Walker<\/a><\/div><p>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Walker_(mobility)\" title=\"Walker (mobility)\" rel=\"external_link\" target=\"_blank\">walker<\/a> or walking frame or Rollator is a tool for disabled people who need additional support to maintain balance or stability while walking. It consists of a frame that is about waist high, approximately twelve inches deep and slightly wider than the user. Walkers are also available in other sizes, such as for children, or for heavy people. Modern walkers are height-adjustable. The front two legs of the walker may or may not have wheels attached depending on the strength and abilities of the person using it. It is also common to see caster wheels or glides on the back legs of a walker with wheels on the front.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><h3><span class=\"mw-headline\" id=\"Prosthesis\">Prosthesis<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">Prosthesis<\/a><\/div><p>A <b>prosthesis<\/b>, <b>prosthetic<\/b>, or <b>prosthetic limb<\/b> is a device that replaces a missing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_body\" title=\"Human body\" rel=\"external_link\" target=\"_blank\">body<\/a> part. It is part of the field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomechatronics\" title=\"Biomechatronics\" rel=\"external_link\" target=\"_blank\">biomechatronics<\/a>, the science of using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mechanical_system\" class=\"mw-redirect\" title=\"Mechanical system\" rel=\"external_link\" target=\"_blank\">mechanical<\/a> devices with human <a href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle\" title=\"Muscle\" rel=\"external_link\" target=\"_blank\">muscle<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skeleton\" title=\"Skeleton\" rel=\"external_link\" target=\"_blank\">skeleton<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nervous_systems\" class=\"mw-redirect\" title=\"Nervous systems\" rel=\"external_link\" target=\"_blank\">nervous systems<\/a> to assist or enhance motor control lost by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trauma_(medicine)\" class=\"mw-redirect\" title=\"Trauma (medicine)\" rel=\"external_link\" target=\"_blank\">trauma<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disease\" title=\"Disease\" rel=\"external_link\" target=\"_blank\">disease<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital_disorder\" class=\"mw-redirect\" title=\"Congenital disorder\" rel=\"external_link\" target=\"_blank\">defect<\/a>. Prostheses are typically used to replace parts lost by injury (traumatic) or missing from birth (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital\" class=\"mw-redirect\" title=\"Congenital\" rel=\"external_link\" target=\"_blank\">congenital<\/a>) or to supplement defective body parts. Inside the body, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_heart_valve\" title=\"Artificial heart valve\" rel=\"external_link\" target=\"_blank\">artificial heart valves<\/a> are in common use with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_heart\" title=\"Artificial heart\" rel=\"external_link\" target=\"_blank\">artificial hearts<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_lung\" title=\"Artificial lung\" rel=\"external_link\" target=\"_blank\">lungs<\/a> seeing less common use but under active technology development. Other medical devices and aids that can be considered prosthetics include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hearing_aids\" class=\"mw-redirect\" title=\"Hearing aids\" rel=\"external_link\" target=\"_blank\">hearing aids<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_prosthesis\" title=\"Visual prosthesis\" rel=\"external_link\" target=\"_blank\">artificial eyes<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Palatal_obturator\" title=\"Palatal obturator\" rel=\"external_link\" target=\"_blank\">palatal obturator<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adjustable_gastric_band\" title=\"Adjustable gastric band\" rel=\"external_link\" target=\"_blank\">gastric bands<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentures\" title=\"Dentures\" rel=\"external_link\" target=\"_blank\">dentures<\/a>.\n<\/p><p>Prostheses are specifically <i>not<\/i> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthoses\" class=\"mw-redirect\" title=\"Orthoses\" rel=\"external_link\" target=\"_blank\">orthoses<\/a>, although given certain circumstances a prosthesis might end up performing some or all of the same functionary benefits as an orthosis. Prostheses are technically the complete finished item. For instance, a C-Leg knee alone is <i>not<\/i> a prosthesis, but only a prosthetic <i>component<\/i>. The complete prosthesis would consist of the attachment system  to the residual limb \u2014 usually a \"socket\", and all the attachment hardware components all the way down to and including the terminal device. Keep this in mind as nomenclature is often interchanged.\n<\/p><p>The terms \"prosthetic\" and \"orthotic\" are adjectives used to describe devices such as a prosthetic knee. The terms \"prosthetics\" and \"orthotics\" are used to describe the respective allied health fields.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Visual_impairments\">Visual impairments<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blindness#Management\" class=\"mw-redirect\" title=\"Blindness\" rel=\"external_link\" target=\"_blank\">Blindness \u00a7 Management<\/a><\/div>\n<p>Many people with serious visual impairments live independently, using a wide range of tools and techniques. Examples of assistive technology for visually impairment include screen readers, screen magnifiers, Braille embossers, desktop video magnifiers, and voice recorders.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Screen_readers\">Screen readers<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screen_reader\" title=\"Screen reader\" rel=\"external_link\" target=\"_blank\">Screen reader<\/a><\/div>\n<p>Screen readers are used to help the visually impaired to easily access electronic information. These software programs run on a computer in order to convey the displayed information through voice (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Text-to-speech\" class=\"mw-redirect\" title=\"Text-to-speech\" rel=\"external_link\" target=\"_blank\">text-to-speech<\/a>) or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Braille\" title=\"Braille\" rel=\"external_link\" target=\"_blank\">braille<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Refreshable_braille_display\" title=\"Refreshable braille display\" rel=\"external_link\" target=\"_blank\">refreshable braille displays<\/a>) in combination with magnification for low vision users in some cases. There are a variety of platforms and applications available for a variety of costs with differing feature sets.\n<\/p><p>One example of screen readers is Apple <a href=\"https:\/\/en.wikipedia.org\/wiki\/VoiceOver\" title=\"VoiceOver\" rel=\"external_link\" target=\"_blank\">VoiceOver<\/a>. This software is provided free of charge on all Apple devices. Apple VoiceOver includes the option to magnify the screen, control the keyboard, and provide verbal descriptions to describe what is happening on the screen. There are thirty languages to select from. It also has the capacity to read aloud file content, as well as web pages, E-mail messages, and word processing files.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:English_braille_sample.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/f\/f9\/English_braille_sample.jpg\/220px-English_braille_sample.jpg\" width=\"220\" height=\"176\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:English_braille_sample.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Braille is a system of raised dots representing letters, numbers, punctuation, and words.<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Braille_and_braille_embossers\">Braille and braille embossers<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Braille\" title=\"Braille\" rel=\"external_link\" target=\"_blank\">Braille<\/a><\/div>\n<p>Braille is a system of raised dots formed into units called braille cells. A full braille cell is made up of six dots, with two parallel rows of three dots, but other combinations and quantities of dots represent other letters, numbers, punctuation marks, or words. People can then use their fingers to read the code of raised dots.\n<\/p><p>A braille embosser is, simply put, a printer for braille. Instead of a standard printer adding ink onto a page, the braille embosser imprints the raised dots of braille onto a page. Some braille embossers combine both braille and ink so the documents can be read with either sight or touch.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Refreshable_braille_display\">Refreshable braille display<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refreshable_braille_display\" title=\"Refreshable braille display\" rel=\"external_link\" target=\"_blank\">Refreshable braille display<\/a><\/div>\n<p>A refreshable braille display or braille terminal is an electro-mechanical device for displaying braille characters, usually by means of round-tipped pins raised through holes in a flat surface. Computer users who cannot use a computer monitor use it to read a braille output version of the displayed text.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Desktop_video_magnifier\">Desktop video magnifier<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Video_magnifier\" title=\"Video magnifier\" rel=\"external_link\" target=\"_blank\">Video magnifier<\/a><\/div>\n<p>Desktop video magnifiers are electronic devices that use a camera and a display screen to perform digital magnification of printed materials. They enlarge printed pages for those with low vision. A camera connects to a monitor that displays real-time images, and the user can control settings such as magnification, focus, contrast, underlining, highlighting, and other screen preferences. They come in a variety of sizes and styles; some are small and portable with handheld cameras, while others are much larger and mounted on a fixed stand.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Screen_magnification_software\">Screen magnification software<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screen_magnifier\" title=\"Screen magnifier\" rel=\"external_link\" target=\"_blank\">Screen magnifier<\/a><\/div>\n<p>A screen magnifier is software that interfaces with a computer's graphical output to present enlarged screen content. It allows users to enlarge the texts and graphics on their computer screens for easier viewing. Similar to desktop video magnifiers, this technology assists people with low vision. After the user loads the software into their computer's memory, it serves as a kind of \"computer magnifying glass.\" Wherever the computer cursor moves, it enlarges the area around it. This allows greater computer accessibility for a wide range of visual abilities.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MAGic_Large_Print_Keyboard.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"MAGic Large Print This MAGic large-print keyboard has tactile elements and special keys for the visually impaired\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/eb\/MAGic_Large_Print_Keyboard.jpg\/220px-MAGic_Large_Print_Keyboard.jpg\" width=\"220\" height=\"114\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MAGic_Large_Print_Keyboard.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><center>This large-print keyboard has tactile elements and special keys for the visually impaired<\/center><\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Large-print_and_tactile_keyboards\">Large-print and tactile keyboards<\/span><\/h3>\n<p>A large-print keyboard has large letters printed on the keys. On the keyboard shown, the round buttons at the top control software which can magnify the screen (zoom in), change the background color of the screen, or make the mouse cursor on the screen larger. The \"bump dots\" on the keys, installed in this case by the organization using the keyboards, help the user find the right keys in a tactile way.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Navigation_Assistance\">Navigation Assistance<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/GPS_for_the_visually_impaired\" title=\"GPS for the visually impaired\" rel=\"external_link\" target=\"_blank\">Assistive technology for navigation<\/a> has exploded on the <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ieeexplore.ieee.org\/Xplore\/home.jsp\" target=\"_blank\">IEEE Xplore database<\/a> since 2000, with over 7,500 engineering articles written on assistive technologies and visual impairment in the past 25 years, and over 1,300 articles on solving the problem of navigation for people who are blind or visually impaired. As well, over 600 articles on augmented reality and visual impairment have appeared in the engineering literature since 2000. Most of these articles were published within the past 5 years, and the number of articles in this area is increasing every year. GPS, accelerometers, gyroscopes, and cameras can pinpoint the exact location of the user and provide information on what's in the immediate vicinity, and assistance in getting to a destination.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Wearable_Technology\">Wearable Technology<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wearable_technology\" title=\"Wearable technology\" rel=\"external_link\" target=\"_blank\">Wearable technology<\/a><\/div>\n<p>Wearable technology are smart electronic devices that can be worn on the body as an implant or an accessory. New technologies are exploring how the visually impaired can receive visual information through wearable devices.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>Some wearable devices for visual impairment include:\n<\/p>\n<ol><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/ESight\" title=\"ESight\" rel=\"external_link\" target=\"_blank\">eSight<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Brainport\" title=\"Brainport\" rel=\"external_link\" target=\"_blank\">Brainport<\/a><\/li><\/ol>\n<h2><span class=\"mw-headline\" id=\"Personal_emergency_response_systems\">Personal emergency response systems<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telecare\" title=\"Telecare\" rel=\"external_link\" target=\"_blank\">Telecare<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Head-wand.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/0e\/Head-wand.jpg\/220px-Head-wand.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Head-wand.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>This voter with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manual_dexterity\" class=\"mw-redirect\" title=\"Manual dexterity\" rel=\"external_link\" target=\"_blank\">manual dexterity<\/a> disability is making choices on a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Touchscreen\" title=\"Touchscreen\" rel=\"external_link\" target=\"_blank\">touchscreen<\/a> with a head dauber<\/div><\/div><\/div>\n<p> (PERS), or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telecare\" title=\"Telecare\" rel=\"external_link\" target=\"_blank\">Telecare<\/a> (UK term), are a particular sort of assistive technology that use electronic sensors connected to an alarm system to help caregivers manage risk and help vulnerable people stay independent at home longer. An example would be the systems being put in place for senior people such as fall detectors, thermometers (for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypothermia\" title=\"Hypothermia\" rel=\"external_link\" target=\"_blank\">hypothermia<\/a> risk), flooding and unlit gas sensors (for people with mild <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dementia\" title=\"Dementia\" rel=\"external_link\" target=\"_blank\">dementia<\/a>). Notably, these alerts can be customized to the particular person's risks. When the alert is triggered, a message is sent to a caregiver or contact center who can respond appropriately.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Accessibility_software\">Accessibility software<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer_accessibility\" title=\"Computer accessibility\" rel=\"external_link\" target=\"_blank\">Computer accessibility<\/a><\/div>\n<p>In human\u2013computer interaction, computer accessibility (also known as accessible computing) refers to the accessibility of a computer system to all people, regardless of disability or severity of impairment, examples include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Web_accessibility\" title=\"Web accessibility\" rel=\"external_link\" target=\"_blank\">web accessibility<\/a> guidelines.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> Another approach is for the user to present a token to the computer terminal, such as a smart card, that has configuration information to adjust the computer speed, text size, etc. to their particular needs. This is useful where users want to access public computer based terminals in Libraries, ATM, Information kiosks etc. The concept is encompassed by the CEN EN 1332-4 Identification Card Systems - Man-Machine Interface.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> This development of this standard has been supported in Europe by <a href=\"https:\/\/en.wikipedia.org\/wiki\/SNAPI\" title=\"SNAPI\" rel=\"external_link\" target=\"_blank\">SNAPI<\/a> and has been successfully incorporated into the specifications, but with limited success due to the lack of interest from public computer terminal suppliers.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Hearing_impairments\">Hearing impairments<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_Technology_for_Deaf_and_Hard_of_Hearing\" title=\"Assistive Technology for Deaf and Hard of Hearing\" rel=\"external_link\" target=\"_blank\">Assistive Technology for Deaf and Hard of Hearing<\/a><\/div>\n<p>People in the d\/Deaf and hard of hearing community have a more difficult time receiving auditory information as compared to hearing individuals. These individuals often rely on visual and tactile mediums for receiving and communicating information. The use of assistive technology and devices provides this community with various solutions to auditory communication needs by providing higher sound (for those who are hard of hearing), tactile feedback, visual cues and improved technology access. Individuals who are deaf or hard of hearing utilize a variety of assistive technologies that provide them with different access to information in numerous environments.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> Most devices either provide amplified sound or alternate ways to access information through vision and\/or vibration. These technologies can be grouped into three general categories: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_Technology_for_Deaf_and_Hard_of_Hearing#Hearing_Technology\" title=\"Assistive Technology for Deaf and Hard of Hearing\" rel=\"external_link\" target=\"_blank\">Hearing Technology<\/a>, alerting devices, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_Technology_for_Deaf_and_Hard_of_Hearing#Communication_Support\" title=\"Assistive Technology for Deaf and Hard of Hearing\" rel=\"external_link\" target=\"_blank\">communication support<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hearing_aids\">Hearing aids<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hearing_aid\" title=\"Hearing aid\" rel=\"external_link\" target=\"_blank\">Hearing aid<\/a><\/div>\n<p>A hearing aid or deaf aid is an electroacoustic device which is designed to amplify sound for the wearer, usually with the aim of making speech more intelligible, and to correct impaired hearing as measured by audiometry. This type of assistive technology helps people with hearing loss participate more fully in their hearing communities by allowing them to hear more clearly. They amplify any and all sound waves through use of a microphone, amplifier, and speaker. There is a wide variety of hearing aids available, including digital, in-the-ear, in-the-canal, behind-the-ear, and on-the-body aids.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Assistive_listening_devices\">Assistive listening devices<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_listening_device\" title=\"Assistive listening device\" rel=\"external_link\" target=\"_blank\">Assistive listening device<\/a><\/div>\n<p>Assistive listening devices include FM, infrared, and loop assistive listening devices. This type of technology allows people with hearing difficulties to focus on a speaker or subject by getting rid of extra background noises and distractions, making places like auditoriums, classrooms, and meetings much easier to participate in. The assistive listening device usually uses a microphone to capture an audio source near to its origin and broadcast it wirelessly over an FM (Frequency Modulation) transmission, IR (Infra Red) transmission, IL (Induction Loop) transmission, or other transmission methods. The person who is listening may use an FM\/IR\/IL Receiver to tune into the signal and listen at his\/her preferred volume.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Amplified_telephone_equipment\">Amplified telephone equipment<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telecommunications_device_for_the_deaf\" title=\"Telecommunications device for the deaf\" rel=\"external_link\" target=\"_blank\">Telecommunications device for the deaf#Other devices for the deaf or hard of hearing<\/a><\/div>\n<p>This type of assistive technology allows users to amplify the volume and clarity of their phone calls so that they can easily partake in this medium of communication. There are also options to adjust the frequency and tone of a call to suit their individual hearing needs. Additionally, there is a wide variety of amplified telephones to choose from, with different degrees of amplification. For example, a phone with 26 to 40 decibel is generally sufficient for mild hearing loss, while a phone with 71 to 90 decibel is better for more severe hearing loss.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Augmentative_and_alternative_communication\">Augmentative and alternative communication<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Augmentative_and_alternative_communication\" title=\"Augmentative and alternative communication\" rel=\"external_link\" target=\"_blank\">Augmentative and alternative communication<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:AAC_user_using_eye_gaze.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5f\/AAC_user_using_eye_gaze.JPG\/220px-AAC_user_using_eye_gaze.JPG\" width=\"220\" height=\"330\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:AAC_user_using_eye_gaze.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An AAC user uses number coding on an eye gaze communication board<\/div><\/div><\/div>\n<p><b>Augmentative and alternative communication (AAC)<\/b> is an umbrella term that encompasses methods of communication for those with impairments or restrictions on the production or comprehension of spoken or written language.<sup id=\"rdp-ebb-cite_ref-asha2005_11-0\" class=\"reference\"><a href=\"#cite_note-asha2005-11\" rel=\"external_link\">[11]<\/a><\/sup> AAC systems are extremely diverse and depend on the capabilities of the user. They may be as basic as pictures on a board that are used to request food, drink, or other care; or they can be advanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Speech_generating_device\" class=\"mw-redirect\" title=\"Speech generating device\" rel=\"external_link\" target=\"_blank\">speech generating devices<\/a>, based on speech synthesis, that are capable of storing hundreds of phrases and words.<sup id=\"rdp-ebb-cite_ref-GillamMarquardt2000_12-0\" class=\"reference\"><a href=\"#cite_note-GillamMarquardt2000-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Cognitive_impairments\">Cognitive impairments<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cognitive_orthotics\" title=\"Cognitive orthotics\" rel=\"external_link\" target=\"_blank\">Cognitive orthotics<\/a><\/div>\n<p>Assistive Technology for Cognition (ATC)<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> is the use of technology (usually high tech) to augment and assist cognitive processes such as attention, memory, self-regulation, navigation, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Emotion_recognition\" title=\"Emotion recognition\" rel=\"external_link\" target=\"_blank\">emotion recognition<\/a> and management, planning, and sequencing activity. Systematic reviews of the field have found that the number of ATC are growing rapidly, but have focused on memory and planning, that there is emerging evidence for efficacy, that a lot of scope exists to develop new ATC.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> Examples of ATC include: which prompts users about meetings,<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wakamaru\" title=\"Wakamaru\" rel=\"external_link\" target=\"_blank\">Wakamaru<\/a>, which provides companionship and reminds users to take medicine and calls for help if something is wrong, and telephone Reassurance systems.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Memory_aids\">Memory aids<\/span><\/h3>\n<p>Memory aids are any type of assistive technology that helps a user learn and remember certain information. Many memory aids are used for cognitive impairments such as reading, writing, or organizational difficulties. For example, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_pen\" title=\"Digital pen\" rel=\"external_link\" target=\"_blank\">Smartpen<\/a> records handwritten notes by creating both a digital copy and an audio recording of the text. Users simply tap certain parts of their notes, the pen saves it, and reads it back to them. From there, the user can also download their notes onto a computer for increased accessibility. Digital voice recorders are also used to record \"in the moment\" information for fast and easy recall at a later time.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Educational_software\">Educational software<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Educational_software\" title=\"Educational software\" rel=\"external_link\" target=\"_blank\">Educational software<\/a><\/div>\n<p>Educational software is software that assists people with reading, learning, comprehension, and organizational difficulties. Any accommodation software such as text readers, notetakers, text enlargers, organization tools, word predictions, and talking word processors falls under the category of educational software.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Eating_Impairments\">Eating Impairments<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_eating_devices\" title=\"Assistive eating devices\" rel=\"external_link\" target=\"_blank\">Assistive eating devices<\/a><\/div>\n<p>Adaptive eating devices include items commonly used by the general population like spoons and forks and plates. However they become assistive technology when they are modified to accommodate the needs of people who have difficultly using standard cutlery due to a disabling condition. Common modifications include increasing the size of the utensil handle to make it easier to grasp. Plates and bowls may have a guard on the edge that stops food being pushed off of the dish when it is being scooped. More sophisticated equipment for eating includes manual and powered feeding devices. These devices support those who have little or no hand and arm function and enable them to eat independently.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"In_sports\">In sports<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:NYC_Marathon_wheelchair.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b5\/NYC_Marathon_wheelchair.jpg\/220px-NYC_Marathon_wheelchair.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:NYC_Marathon_wheelchair.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_York_City_Marathon\" title=\"New York City Marathon\" rel=\"external_link\" target=\"_blank\">New York City Marathon<\/a> competitor uses a racing wheelchair<\/div><\/div><\/div>\n<p>Assistive technology in sports is an area of technology design that is growing. Assistive technology is the array of new devices created to enable sports enthusiasts who have disabilities to play. Assistive technology may be used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adaptive_sports\" class=\"mw-redirect\" title=\"Adaptive sports\" rel=\"external_link\" target=\"_blank\">adaptive sports<\/a>, where an existing sport is modified to enable players with a disability to participate; or, assistive technology may be used to invent completely new sports with athletes with disabilities exclusively in mind.\n<\/p><p>An increasing number of people with disabilities are participating in sports, leading to the development of new assistive technology.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> Assistive technology devices can be simple, or \"low-tech\", or they may use highly advanced technology. \"Low-tech\" devices can include velcro gloves and adaptive bands and tubes. \"High-tech\" devices can include all-terrain wheelchairs and adaptive bicycles.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> Accordingly, assistive technology can be found in sports ranging from local community recreation to the elite <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paralympic_Games\" title=\"Paralympic Games\" rel=\"external_link\" target=\"_blank\">Paralympic Games<\/a>. More complex assistive technology devices have been developed over time, and as a result, sports for people with disabilities \"have changed from being a clinical therapeutic tool to an increasingly competition-oriented activity\".<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"In_education\">In education<\/span><\/h2>\n<p>In the United States there are two major pieces of legislation that govern the use of assistive technology within the school system. The first is Section 504 of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rehabilitation_Act_of_1973\" title=\"Rehabilitation Act of 1973\" rel=\"external_link\" target=\"_blank\">Rehabilitation Act of 1973<\/a> and the second being the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Individuals_with_Disabilities_Education_Act\" title=\"Individuals with Disabilities Education Act\" rel=\"external_link\" target=\"_blank\">Individuals with Disabilities Education Act<\/a> (IDEA) which was first enacted in 1975 under the name The Education for All Handicapped Children Act. In 2004, during the reauthorization period for IDEA, the National Instructional Material Access Center (NIMAC) was created which provided a repository of accessible text including publisher's textbooks to students with a qualifying disability. Files provided are in XML format and used as a starting platform for braille readers, screen readers, and other digital text software.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> IDEA defines assistive technology as follows: \"any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability. (B) Exception.--The term does not include a medical device that is surgically implanted, or the replacement of such device.\"<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p><p>Assistive technology in this area is broken down into low, mid, and high tech categories. Low tech encompasses equipment that is often low cost and does not include batteries or requires charging. Examples include adapted paper and pencil grips for writing or masks and color overlays for reading. Mid tech supports used in the school setting include the use of handheld spelling dictionaries and portable word processors used to keyboard writing. High tech supports involve the use of tablet devices and computers with accompanying software. Software supports for writing include the use of auditory feedback while keyboarding, word prediction for spelling, and speech to text. Supports for reading include the use of text to speech (TTS) software and font modification via access to digital text. Limited supports are available for math instruction and mostly consist of grid based software to allow younger students to keyboard equations and auditory feedback of more complex equations using MathML and Daisy.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Computer_accessibility\">Computer accessibility<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer_accessibility\" title=\"Computer accessibility\" rel=\"external_link\" target=\"_blank\">Computer accessibility<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sip-and-puff_device.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/05\/Sip-and-puff_device.jpg\/220px-Sip-and-puff_device.jpg\" width=\"220\" height=\"293\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sip-and-puff_device.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sip-and-puff\" title=\"Sip-and-puff\" rel=\"external_link\" target=\"_blank\">sip-and-puff<\/a> device which allows a person with substantial disability to make selections and navigate computerized interfaces by controlling inhalations and exhalations<\/div><\/div><\/div>\n<p>One of the largest problems that affect people with disabilities is discomfort with prostheses.<sup id=\"rdp-ebb-cite_ref-hussein_23-0\" class=\"reference\"><a href=\"#cite_note-hussein-23\" rel=\"external_link\">[23]<\/a><\/sup> An experiment performed in Massachusetts utilized 20 people with various sensors attached to their arms.<sup id=\"rdp-ebb-cite_ref-hussein_23-1\" class=\"reference\"><a href=\"#cite_note-hussein-23\" rel=\"external_link\">[23]<\/a><\/sup> The subjects tried different arm exercises, and the sensors recorded their movements. All of the data helped engineers develop new engineering concepts for prosthetics.<sup id=\"rdp-ebb-cite_ref-hussein_23-2\" class=\"reference\"><a href=\"#cite_note-hussein-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p><p>Assistive technology may attempt to improve the ergonomics of the devices themselves such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dvorak_Simplified_Keyboard\" title=\"Dvorak Simplified Keyboard\" rel=\"external_link\" target=\"_blank\">Dvorak<\/a> and other alternative keyboard layouts, which offer more ergonomic layouts of the keys.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<p>Assistive technology devices have been created to enable people with disabilities to use modern touch screen mobile computers such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/IPad\" title=\"IPad\" rel=\"external_link\" target=\"_blank\">iPad<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/IPhone\" title=\"IPhone\" rel=\"external_link\" target=\"_blank\">iPhone<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/IPod_touch\" class=\"mw-redirect\" title=\"IPod touch\" rel=\"external_link\" target=\"_blank\">iPod touch<\/a>. The Pererro is a plug and play adapter for <a href=\"https:\/\/en.wikipedia.org\/wiki\/IOS\" title=\"IOS\" rel=\"external_link\" target=\"_blank\">iOS<\/a> devices which uses the built in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apple_VoiceOver\" class=\"mw-redirect\" title=\"Apple VoiceOver\" rel=\"external_link\" target=\"_blank\">Apple VoiceOver<\/a> feature in combination with a basic switch. This brings touch screen technology to those who were previously unable to use it. Apple, with the release of iOS 7 had introduced the ability to navigate apps using switch control. Switch access could be activated either through an external bluetooth connected switch, single touch of the screen, or use of right and left head turns using the device's camera. Additional accessibility features include the use of Assistive Touch which allows a user to access multi-touch gestures through pre-programmed onscreen buttons.\n<\/p>\n<\/p><p>For users with physical disabilities a large variety of switches are available and customizable to the user's needs varying in size, shape, or amount of pressure required for activation. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Switch_access\" title=\"Switch access\" rel=\"external_link\" target=\"_blank\">Switch access<\/a> may be placed near any area of the body which has consistent and reliable mobility and less subject to fatigue. Common sites include the hands, head, and feet. Eye gaze and head mouse systems can also be used as an alternative mouse navigation. A user may utilize single or multiple switch sites and the process often involves a scanning through items on a screen and activating the switch once the desired object is highlighted.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Home_automation\">Home automation<\/span><\/h2>\n<p>The form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Home_automation\" title=\"Home automation\" rel=\"external_link\" target=\"_blank\">home automation<\/a> called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_domotics\" class=\"mw-redirect\" title=\"Assistive domotics\" rel=\"external_link\" target=\"_blank\">assistive domotics<\/a> focuses on making it possible for elderly and disabled people to live independently. Home automation is becoming a viable option for the elderly and disabled who would prefer to stay in their own homes rather than move to a healthcare facility. This field uses much of the same technology and equipment as home automation for security, entertainment, and energy conservation but tailors it towards elderly and disabled users. For example, automated prompts and reminders utilize motion sensors and pre-recorded audio messages; an automated prompt in the kitchen may remind the resident to turn off the oven, and one by the front door may remind the resident to lock the door.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Impacts\">Impacts<\/span><\/h2>\n<p>Overall, assistive technology aims to allow people with disabilities to \"participate more fully in all aspects of life (home, school, and community)\" and increases their opportunities for \"education, social interactions, and potential for meaningful employment\".<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> It creates greater independence and control for disabled individuals. For example, in one study of 1,342 infants, toddlers and preschoolers, all with some kind of developmental, physical, sensory, or cognitive disability, the use of assistive technology created improvements in child development.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> These included improvements in \"cognitive, social, communication, literacy, motor, adaptive, and increases in engagement in learning activities\".<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> Additionally, it has been found to lighten caregiver load.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> Both family and professional caregivers benefit from assistive technology. Through its use, the time that a family member or friend would need to care for a patient significantly decreases. However, studies show that care time for a professional caregiver increases when assistive technology is used. Nonetheless, their work load is significantly easier as the assistive technology frees them of having to perform certain tasks.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> There are several platforms that use machine learning to identify the appropriate assistive device to suggest to patients, making assistive devices more accessible.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 20em; -webkit-column-width: 20em; column-width: 20em; font-size:90%;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Accessibility\" title=\"Accessibility\" rel=\"external_link\" target=\"_blank\">Accessibility<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Assisted_Living\" class=\"mw-redirect\" title=\"Assisted Living\" rel=\"external_link\" target=\"_blank\">Assisted Living<\/a><\/li>\n<li><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Augmentative_and_alternative_communication\" title=\"Augmentative and alternative communication\" rel=\"external_link\" target=\"_blank\">Augmentative and alternative communication<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Braille_technology\" title=\"Braille technology\" rel=\"external_link\" target=\"_blank\">Braille technology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Design_for_All_(in_ICT)\" title=\"Design for All (in ICT)\" rel=\"external_link\" target=\"_blank\">Design for All (in ICT)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Durable_medical_equipment\" title=\"Durable medical equipment\" rel=\"external_link\" target=\"_blank\">Durable medical equipment<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Matching_Person_%26_Technology_Model\" class=\"mw-redirect\" title=\"Matching Person & Technology Model\" rel=\"external_link\" target=\"_blank\">Matching Person & Technology Model<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/OATS\" title=\"OATS\" rel=\"external_link\" target=\"_blank\">OATS<\/a>: Open Source Assistive Technology Software<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Occupational_Therapy\" class=\"mw-redirect\" title=\"Occupational Therapy\" rel=\"external_link\" target=\"_blank\">Occupational Therapy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Transgenerational_design\" title=\"Transgenerational design\" rel=\"external_link\" target=\"_blank\">Transgenerational design<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Universal_access_to_education\" title=\"Universal access to education\" rel=\"external_link\" target=\"_blank\">Universal access to education<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<dl><dt>Source<\/dt><\/dl>\n<ul><li><span id=\"rdp-ebb-refASHA2005\" class=\"citation\"><cite class=\"citation web\">American Speech-Language-Hearing Association. (2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090213100431\/http:\/\/asha.org\/docs\/html\/PS2005-00113.html\" target=\"_blank\">\"Roles and Responsibilities of Speech-Language Pathologists With Respect to Augmentative and Alternative Communication: Position Statement\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.asha.org\/docs\/html\/PS2005-00113.html\" target=\"_blank\">the original<\/a> on February 13, 2009<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">January 23,<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Roles+and+Responsibilities+of+Speech-Language+Pathologists+With+Respect+to+Augmentative+and+Alternative+Communication%3A+Position+Statement&rft.date=2005&rft.au=American+Speech-Language-Hearing+Association.&rft_id=http%3A%2F%2Fwww.asha.org%2Fdocs%2Fhtml%2FPS2005-00113.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><\/span><\/li>\n<li><span id=\"rdp-ebb-refGlennenDeCoste\" class=\"citation\"><cite class=\"citation book\">DeCoste, Denise C. (1997). \"Chapter 10: Introduction to Augmentative and Alternative Communication Systems\". In Glennen, Sharon; DeCoste, Denise C. <i>Handbook Of Augmentative And Alternative Communication<\/i>. San Diego, CA: Singular Publishing Group. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-56593-684-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+10%3A+Introduction+to+Augmentative+and+Alternative+Communication+Systems&rft.btitle=Handbook+Of+Augmentative+And+Alternative+Communication&rft.place=San+Diego%2C+CA&rft.pub=Singular+Publishing+Group&rft.date=1997&rft.isbn=1-56593-684-1&rft.aulast=DeCoste&rft.aufirst=Denise+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li>\n<li><span id=\"rdp-ebb-refSchlosserWendt\" class=\"citation\"><cite class=\"citation journal\">Schlosser, R. W.; Wendt, O. (2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.researchgate.net\/publication\/23133712\" target=\"_blank\">\"Effects of augmentative and alternative communication intervention on speech production in children with autism: a systematic review\"<\/a>. <i>American Journal of Speech-Language Pathology<\/i>. <b>17<\/b> (3): 212\u2013230. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1044%2F1058-0360%282008%2F021%29\" target=\"_blank\">10.1044\/1058-0360(2008\/021)<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18663107\" target=\"_blank\">18663107<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Speech-Language+Pathology&rft.atitle=Effects+of+augmentative+and+alternative+communication+intervention+on+speech+production+in+children+with+autism%3A+a+systematic+review&rft.volume=17&rft.issue=3&rft.pages=212-230&rft.date=2008&rft_id=info%3Adoi%2F10.1044%2F1058-0360%282008%2F021%29&rft_id=info%3Apmid%2F18663107&rft.au=Schlosser%2C+R.+W.&rft.au=Wendt%2C+O.&rft_id=https%3A%2F%2Fwww.researchgate.net%2Fpublication%2F23133712&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li>\n<li><span id=\"rdp-ebb-refBeukelmanMirenda\" class=\"citation\"><cite class=\"citation book\">Beukelman, David R.; Mirenda, Pat (2005). <i>Augmentative & alternative communication: supporting children & adults with complex communication needs<\/i> (3rd ed.). Paul H. Brookes Publishing Company. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-55766-684-0.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Augmentative+%26+alternative+communication%3A+supporting+children+%26+adults+with+complex+communication+needs&rft.edition=3rd&rft.pub=Paul+H.+Brookes+Publishing+Company&rft.date=2005&rft.isbn=978-1-55766-684-0&rft.au=Beukelman%2C+David+R.&rft.au=Mirenda%2C+Pat&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li>\n<li><span id=\"rdp-ebb-refGalv\u00e3o_Filho2009\" class=\"citation\"><cite class=\"citation journal\">Galv\u00e3o Filho, T. (2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.galvaofilho.net\/tese.htm\" target=\"_blank\">\"Tecnologia Assistiva para uma Escola Inclusiva: apropria\u00e7\u00e3o, demandas e perspectivas. Tese (Doutorado em Educa\u00e7\u00e3o) \u2013 Faculdade de Educa\u00e7\u00e3o, Universidade Federal da Bahia, Salvador, Brazil\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Tecnologia+Assistiva+para+uma+Escola+Inclusiva%3A+apropria%C3%A7%C3%A3o%2C+demandas+e+perspectivas.+Tese+%28Doutorado+em+Educa%C3%A7%C3%A3o%29+%E2%80%93+Faculdade+de+Educa%C3%A7%C3%A3o%2C+Universidade+Federal+da+Bahia%2C+Salvador%2C+Brazil&rft.date=2009&rft.aulast=Galv%C3%A3o+Filho&rft.aufirst=T.&rft_id=http%3A%2F%2Fwww.galvaofilho.net%2Ftese.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li>\n<li><span id=\"rdp-ebb-refMirenda2003\" class=\"citation\"><cite class=\"citation journal\">Mirenda, P. (2003). \"Toward Functional Augmentative and Alternative Communication for Students With Autism: Manual Signs, Graphic Symbols, and Voice Output Communication Aids\". <i>Language, Speech, & Hearing Services in Schools<\/i>. <b>34<\/b> (3): 203\u2013216. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1044%2F0161-1461%282003%2F017%29\" target=\"_blank\">10.1044\/0161-1461(2003\/017)<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Language%2C+Speech%2C+%26+Hearing+Services+in+Schools&rft.atitle=Toward+Functional+Augmentative+and+Alternative+Communication+for+Students+With+Autism%3A+Manual+Signs%2C+Graphic+Symbols%2C+and+Voice+Output+Communication+Aids&rft.volume=34&rft.issue=3&rft.pages=203-216&rft.date=2003&rft_id=info%3Adoi%2F10.1044%2F0161-1461%282003%2F017%29&rft.aulast=Mirenda&rft.aufirst=P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li>\n<li><span id=\"rdp-ebb-refMathy2000\" class=\"citation\"><cite class=\"citation book\">Mathy; Yorkston, K.; Guttman (2000). \"Augmentative Communication for Individuals with Amyotrophic Lateral Sclerosis\". In Beukelman, D.; Yorkston, K.; Reichle, J. <i>Augmentative and Alternative Communication Disorders for Adults with Acquired Neurologic Disorders<\/i>. Baltimore: P. H. Brookes Pub. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-55766-473-0.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Augmentative+Communication+for+Individuals+with+Amyotrophic+Lateral+Sclerosis&rft.btitle=Augmentative+and+Alternative+Communication+Disorders+for+Adults+with+Acquired+Neurologic+Disorders&rft.place=Baltimore&rft.pub=P.+H.+Brookes+Pub.&rft.date=2000&rft.isbn=978-1-55766-473-0&rft.au=Mathy&rft.au=Yorkston%2C+K.&rft.au=Guttman&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li>\n<li><span id=\"rdp-ebb-refJansClark\" class=\"citation\"><cite class=\"citation book\">Jans, Deborah; Clark, Sue (1998). \"Chapter 6: High Technology Aids to Communication\". In Wilson, Allan. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.callscotland.org.uk\/Resources\/Books\/Augmentative-Communication-in-Practice\/\" target=\"_blank\"><i>Augmentative Communication in Practice: An Introduction<\/i><\/a>. University of Edinburgh. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-898042-15-0.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+6%3A+High+Technology+Aids+to+Communication&rft.btitle=Augmentative+Communication+in+Practice%3A+An+Introduction&rft.pub=University+of+Edinburgh&rft.date=1998&rft.isbn=978-1-898042-15-0&rft.au=Jans%2C+Deborah&rft.au=Clark%2C+Sue&rft_id=http%3A%2F%2Fwww.callscotland.org.uk%2FResources%2FBooks%2FAugmentative-Communication-in-Practice%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li>\n<li><span id=\"rdp-ebb-refParetteEtal2000\" class=\"citation\"><cite class=\"citation journal\">Parette, H. P.; Brotherson, M. J; Huer, M. B. (2000). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/psycnet.apa.org\/psycinfo\/2001-17960-006\" target=\"_blank\">\"Giving families a voice in augmentative and alternative communication decision-making\"<\/a>. <i>Education and Training in Mental Retardation and Developmental Disabilities<\/i>. <b>35<\/b>: 177\u2013190.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Education+and+Training+in+Mental+Retardation+and+Developmental+Disabilities&rft.atitle=Giving+families+a+voice+in+augmentative+and+alternative+communication+decision-making&rft.volume=35&rft.pages=177-190&rft.date=2000&rft.aulast=Parette&rft.aufirst=H.+P.&rft.au=Brotherson%2C+M.+J&rft.au=Huer%2C+M.+B.&rft_id=http%3A%2F%2Fpsycnet.apa.org%2Fpsycinfo%2F2001-17960-006&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span><\/li><\/ul>\n<dl><dt>Notes<\/dt><\/dl>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Parant, Aymeric; Schiano-Lomoriello, Sandrine; Marchan, Francis (October 2017). \"How would I live with a disability? Expectations of bio-psychosocial consequences and assistive technology use\". <i>Disability and Rehabilitation. Assistive Technology<\/i>. <b>12<\/b> (7): 681\u2013685. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F17483107.2016.1218555\" target=\"_blank\">10.1080\/17483107.2016.1218555<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1748-3115\" target=\"_blank\">1748-3115<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27677931\" target=\"_blank\">27677931<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Disability+and+Rehabilitation.+Assistive+Technology&rft.atitle=How+would+I+live+with+a+disability%3F+Expectations+of+bio-psychosocial+consequences+and+assistive+technology+use&rft.volume=12&rft.issue=7&rft.pages=681-685&rft.date=2017-10&rft.issn=1748-3115&rft_id=info%3Apmid%2F27677931&rft_id=info%3Adoi%2F10.1080%2F17483107.2016.1218555&rft.aulast=Parant&rft.aufirst=Aymeric&rft.au=Schiano-Lomoriello%2C+Sandrine&rft.au=Marchan%2C+Francis&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/section508.gov\/assistive-technology-act-1998\" target=\"_blank\">\"Assistive Technology Act of 1998 | Section508.gov\"<\/a>. <i>section508.gov<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2016-04-04<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=section508.gov&rft.atitle=Assistive+Technology+Act+of+1998+%7C+Section508.gov&rft_id=http%3A%2F%2Fsection508.gov%2Fassistive-technology-act-1998&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/glencoe.mcgraw-hill.com\/sites\/dl\/free\/0078901359\/594902\/AAT_v4.pdf\" target=\"_blank\">\"Tennessee Science Standards\"<\/a> <span class=\"cs1-format\">(PDF)<\/span><span class=\"reference-accessdate\">. 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Universitat Polit\u00e8cnica de Catalunya. 2012<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Pardes, Arielle. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.wired.com\/story\/wearables-for-the-blind\/\" target=\"_blank\">\"The Wearables Giving Computer Vision to the Blind\"<\/a>. <i>Wired<\/i>. Wired<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 September<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Wired&rft.atitle=The+Wearables+Giving+Computer+Vision+to+the+Blind&rft.aulast=Pardes&rft.aufirst=Arielle&rft_id=https%3A%2F%2Fwww.wired.com%2Fstory%2Fwearables-for-the-blind%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.learningdisabilities.org.uk\/page.cfm?pagecode=ISSIWD\" target=\"_blank\">Web accessibility guidelines<\/a><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cen.eu\/cen\/Sectors\/TechnicalCommitteesWorkshops\/CENTechnicalCommittees\/Pages\/TCStruc.aspx?param=6205&title=Personal%20identification,%20electronic%20signature%20and%20cards%20and%20their%20related%20systems%20and%20operations\" target=\"_blank\">CEN EN 1332-4 Identification Card Systems - Man-Machine Interface<\/a><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.wati.org\/content\/supports\/free\/pdf\/Ch13-Hearing.pdf\" target=\"_blank\">\"Assistive Technology for Individuals who are Deaf or Hard of Hearing\"<\/a> <span class=\"cs1-format\">(PDF)<\/span><span class=\"reference-accessdate\">. 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(2004). Assistive Technology for cognitive rehabilitation: State of the art. Neuropsychological Rehabilitation, 14, 5-39.<\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Gillespie, A., Best, C. & O'Neill, B. (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/lse.academia.edu\/AlexGillespie\/Papers\/1347581\/Cognitive_function_and_assistive_technology_for_cognition_A_systematic_review\" target=\"_blank\">Cognitive function and Assistive Technology for cognition: A systematic review<\/a>. Journal of the International Neuropsychological Society, 18, 1-19.<\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Wilson, et al. (1997). Evaluation of NeuroPage: A new memory aid. 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(1988). \"An enhanced standard computer keyboard system for single-finger and typing-stick typing\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Journal_of_Rehabilitation_Research_and_Development\" title=\"Journal of Rehabilitation Research and Development\" rel=\"external_link\" target=\"_blank\">Journal of Rehabilitation Research and Development<\/a><\/i>. <b>25<\/b> (4): 17\u201324. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2973523\" target=\"_blank\">2973523<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Rehabilitation+Research+and+Development&rft.atitle=An+enhanced+standard+computer+keyboard+system+for+single-finger+and+typing-stick+typing&rft.volume=25&rft.issue=4&rft.pages=17-24&rft.date=1988&rft_id=info%3Apmid%2F2973523&rft.au=Chubon%2C+R.A.&rft.au=Hester%2C+M.R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Anson, D.; George, S.; Galup, R.; Shea, B.; Vetter, R. (2001). \"Efficiency of the Chubon versus the QWERTY keyboard\". <i>Assistive-Technology<\/i>. <b>13<\/b> (1): 40\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F10400435.2001.10132032\" target=\"_blank\">10.1080\/10400435.2001.10132032<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12212435\" target=\"_blank\">12212435<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Assistive-Technology&rft.atitle=Efficiency+of+the+Chubon+versus+the+QWERTY+keyboard&rft.volume=13&rft.issue=1&rft.pages=40-5&rft.date=2001&rft_id=info%3Adoi%2F10.1080%2F10400435.2001.10132032&rft_id=info%3Apmid%2F12212435&rft.au=Anson%2C+D.&rft.au=George%2C+S.&rft.au=Galup%2C+R.&rft.au=Shea%2C+B.&rft.au=Vetter%2C+R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Judd, Natasha. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.alzheimers.org.uk\/site\/scripts\/documents_info.php?documentID=109\" target=\"_blank\">\"Assistive technology - devices to help with everyday living\"<\/a>. <i>www.alzheimers.org.uk<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-11-30<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.alzheimers.org.uk&rft.atitle=Assistive+technology+-+devices+to+help+with+everyday+living&rft.aulast=Judd&rft.aufirst=Natasha&rft_id=https%3A%2F%2Fwww.alzheimers.org.uk%2Fsite%2Fscripts%2Fdocuments_info.php%3FdocumentID%3D109&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.parentcenterhub.org\/repository\/considering-at\/\" target=\"_blank\">\"Considering Assistive Technology | Center for Parent Information and Resources\"<\/a>. <i>www.parentcenterhub.org<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-11-25<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.parentcenterhub.org&rft.atitle=Considering+Assistive+Technology+%7C+Center+for+Parent+Information+and+Resources&rft_id=http%3A%2F%2Fwww.parentcenterhub.org%2Frepository%2Fconsidering-at%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Desch, Larry W.; Gaebler-Spira, Deborah (2008-06-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pediatrics.aappublications.org\/content\/121\/6\/1271\" target=\"_blank\">\"Prescribing Assistive-Technology Systems: Focus on Children With Impaired Communication\"<\/a>. <i>Pediatrics<\/i>. <b>121<\/b> (6): 1271\u20131280. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1542%2Fpeds.2008-0695\" target=\"_blank\">10.1542\/peds.2008-0695<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0031-4005\" target=\"_blank\">0031-4005<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18519500\" target=\"_blank\">18519500<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pediatrics&rft.atitle=Prescribing+Assistive-Technology+Systems%3A+Focus+on+Children+With+Impaired+Communication&rft.volume=121&rft.issue=6&rft.pages=1271-1280&rft.date=2008-06-01&rft.issn=0031-4005&rft_id=info%3Apmid%2F18519500&rft_id=info%3Adoi%2F10.1542%2Fpeds.2008-0695&rft.aulast=Desch&rft.aufirst=Larry+W.&rft.au=Gaebler-Spira%2C+Deborah&rft_id=http%3A%2F%2Fpediatrics.aappublications.org%2Fcontent%2F121%2F6%2F1271&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Dunst, Trivette; Hamby, Simkus (August 2013). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/community.fpg.unc.edu\/sites\/community.fpg.unc.edu\/files\/resources\/Handout\/CONNECT-Handout-5-1.pdf\" target=\"_blank\">\"Research Summary on Assistive Technology Interventions\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Community<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">24 November<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Community&rft.atitle=Research+Summary+on+Assistive+Technology+Interventions&rft.date=2013-08&rft.au=Dunst%2C+Trivette&rft.au=Hamby%2C+Simkus&rft_id=http%3A%2F%2Fcommunity.fpg.unc.edu%2Fsites%2Fcommunity.fpg.unc.edu%2Ffiles%2Fresources%2FHandout%2FCONNECT-Handout-5-1.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Nicolson, Amy; Moir, Lois; Millsteed, Jeannine (22 March 2012). \"Impact of assistive technology on family caregivers of children with physical disabilities: a systematic review\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Disability_and_Rehabilitation:_Assistive_Technology\" title=\"Disability and Rehabilitation: Assistive Technology\" rel=\"external_link\" target=\"_blank\">Disability and Rehabilitation: Assistive Technology<\/a><\/i>. <b>7<\/b> (5): 345\u2013349. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3109%2F17483107.2012.667194\" target=\"_blank\">10.3109\/17483107.2012.667194<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Disability+and+Rehabilitation%3A+Assistive+Technology&rft.atitle=Impact+of+assistive+technology+on+family+caregivers+of+children+with+physical+disabilities%3A+a+systematic+review&rft.volume=7&rft.issue=5&rft.pages=345-349&rft.date=2012-03-22&rft_id=info%3Adoi%2F10.3109%2F17483107.2012.667194&rft.aulast=Nicolson&rft.aufirst=Amy&rft.au=Moir%2C+Lois&rft.au=Millsteed%2C+Jeannine&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Anderson, Wayne L.; Wiener, Joshua M. (2015-06-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/academic.oup.com\/gerontologist\/article\/588347\/The\" target=\"_blank\">\"The Impact of Assistive Technologies on Formal and Informal Home Care\"<\/a>. <i>The Gerontologist<\/i>. <b>55<\/b> (3): 422\u2013433. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Fgeront%2Fgnt165\" target=\"_blank\">10.1093\/geront\/gnt165<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0016-9013\" target=\"_blank\">0016-9013<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Gerontologist&rft.atitle=The+Impact+of+Assistive+Technologies+on+Formal+and+Informal+Home+Care&rft.volume=55&rft.issue=3&rft.pages=422-433&rft.date=2015-06-01&rft_id=info%3Adoi%2F10.1093%2Fgeront%2Fgnt165&rft.issn=0016-9013&rft.aulast=Anderson&rft.aufirst=Wayne+L.&rft.au=Wiener%2C+Joshua+M.&rft_id=https%3A%2F%2Facademic.oup.com%2Fgerontologist%2Farticle%2F588347%2FThe&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAssistive+technology\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.atvisor.ai\/\" target=\"_blank\">https:\/\/www.atvisor.ai\/<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1324\nCached time: 20181211204418\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.580 seconds\nReal time usage: 0.707 seconds\nPreprocessor visited node count: 2115\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 91343\/2097152 bytes\nTemplate argument size: 559\/2097152 bytes\nHighest expansion depth: 14\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 76893\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.345\/10.000 seconds\nLua memory usage: 5.58 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 574.594 1 -total\n<\/p>\n<pre>31.50% 180.995 1 Template:Reflist\n27.88% 160.217 14 Template:Cite_web\n16.63% 95.539 11 Template:Cite_journal\n15.63% 89.786 1 Template:Commons_category\n13.69% 78.664 1 Template:Commons\n13.28% 76.309 1 Template:Sister_project\n12.71% 73.007 1 Template:Side_box\n10.99% 63.125 2 Template:If_then_show\n 6.64% 38.177 1 Template:Authority_control\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:653-1!canonical and timestamp 20181211204418 and revision id 871292764\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Assistive_technology\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214708\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.165 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 156.883 1 - wikipedia:Assistive_technology\n100.00% 156.883 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8573-0!*!*!*!*!*!* and timestamp 20181217214708 and revision id 25001\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Assistive_technology\">https:\/\/www.limswiki.org\/index.php\/Assistive_technology<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","66f165c46927036533e0a0dd6571a8b1_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c0\/Hoergeraet_analog_050609.jpg\/440px-Hoergeraet_analog_050609.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/f\/f9\/English_braille_sample.jpg\/440px-English_braille_sample.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/eb\/MAGic_Large_Print_Keyboard.jpg\/440px-MAGic_Large_Print_Keyboard.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/0e\/Head-wand.jpg\/440px-Head-wand.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5f\/AAC_user_using_eye_gaze.JPG\/440px-AAC_user_using_eye_gaze.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b5\/NYC_Marathon_wheelchair.jpg\/440px-NYC_Marathon_wheelchair.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/05\/Sip-and-puff_device.jpg\/440px-Sip-and-puff_device.jpg"],"66f165c46927036533e0a0dd6571a8b1_timestamp":1545083228,"a0550ad91421c65fcff8f1e3ca9b41d9_type":"article","a0550ad91421c65fcff8f1e3ca9b41d9_title":"Adverse event","a0550ad91421c65fcff8f1e3ca9b41d9_url":"https:\/\/www.limswiki.org\/index.php\/Adverse_event","a0550ad91421c65fcff8f1e3ca9b41d9_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tAdverse event\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor the House episode, see Adverse Events.\nThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (May 2013) (Learn how and when to remove this template message)\nAn adverse event (AE) is any untoward medical occurrence in a patient or clinical investigation subject administered a pharmaceutical product and which does not necessarily have a causal relationship with this treatment. An adverse event (AE) can therefore be any unfavourable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal (investigational) product, whether or not related to the medicinal (investigational) product.[1]\nAEs in patients participating in clinical trials must be reported to the study sponsor and if required could be reported to local ethics committee . Adverse events categorized as \"serious\" ( results in death, illness requiring hospitalization, events deemed life-threatening, results in persistent or significant disability\/incapacity, a congenital anomaly\/birth defect or medically important condition) must be reported to the regulatory authorities immediately, whereas non-serious adverse events are merely documented in the annual summary sent to the regulatory authority.\nThe sponsor collects AE reports from the local researchers, and notifies all participating sites of the AEs at the other sites, as well as both the local investigators' and the sponsors' judgment of the seriousness of the AEs. This process allows the sponsor and all the local investigators access to a set of data that might suggest potential problems with the study treatment while the study is still ongoing.\n\nContents \n\n1 Types of adverse events \n2 Reporting of adverse events \n3 Grades of AE \n4 Database of adverse events \n5 See also \n6 References \n7 External links \n\n\nTypes of adverse events \nAll clinical trials have the potential to produce AEs. AEs are classified as serious or non-serious; expected or unexpected; and study-related, possibly study-related, or not study-related.\nFor example, while a study that tests the effectiveness of a new blood pressure cuff for a period of 10 minutes might seem innocuous, the potential exists for the patient's skin to be irritated by the device. Patients in that study might also die during that 10-minute period. Both skin irritation and sudden death would be considered AEs. In this case, the skin irritation would be classified as not serious, unexpected, and possibly study-related. The death would be classified as serious and unexpected (unless the patient was already at death's door). The local researcher would use his\/her medical judgment to determine whether the death could have been related to the study device.\nBoth the skin irritation and the death are unexpected events, and should alert the researcher to the potential existence of a problem with the device (for instance, it could have malfunctioned and shocked the patient). The researcher would report these AEs to the local Institutional Review Board and to the sponsor, and await direction on whether to stop the study. If the researcher feels there is an imminent danger posed by the device, he or she can use medical discretion to stop patients from participating in the study.\nAn adverse event can also be declared in the normal treatment of a patient which is suspected of being caused by the medication being taken or a medical device used in the treatment of the patient.\nIn Australia, 'Adverse EVENT' refers generically to medical errors of all kinds, surgical, medical or nursing related. The most recent available official study (1995) indicated 18,000 deaths per year are a result of hospital care. The Medical Error Action Group is lobbying for legislation to improve the reporting of AEs and through quality control, minimize the needless deaths.\n\nReporting of adverse events \nMain article: Monitoring in clinical trials\nResearchers participating in a clinical trial must report all adverse events to the drug regulatory authority of the respective country where the drug or device is to be registered [e.g. Food and Drug Administration (FDA) if it is US]. Serious AEs must be reported immediately; minor AEs are 'bundled' by the sponsor and submitted later.\n\nGrades of AE \nClinical trial results often report the number of grade 3 and grade 4 adverse events.\nGrades are defined:[2]\n\nGrade 1 Mild AE\nGrade 2 Moderate AE\nGrade 3 Severe AE\nGrade 4 Life-threatening or disabling AE\nGrade 5 Death related to AE\nDatabase of adverse events \nThe examples and perspective in this section deal primarily with the United States and do not represent a worldwide view of the subject. You may improve this article, discuss the issue on the talk page, or create a new article, as appropriate. (July 2018) (Learn how and when to remove this template message)\nThe FDA provides a database for reporting of adverse events called the Manufacturer and User Facility Device Experience Database (MAUDE)[1]. The data consist of voluntary reports since June 1993, user facility reports since 1991, distributor reports since 1993, and manufacturer reports since August 1996, and is open for public view. Two private companies have also recently started providing access to analyzed adverse event information: Clarimed provides adverse event information for medical devices and AdverseEvents provides adverse event data for drugs.\n\nSee also \n\nClinical trial\nGood clinical practice (GCP)\nData monitoring committees\nSerious adverse event\nAdverse effect\nAdverse drug reaction\nPharmacovigilance\nEudraVigilance (European Union AE reporting and evaluating network)\nClinical Trials Directive (Directive 2001\/20\/EC by European Union)\nAdverse Event Reporting System\nYellow Card Scheme\n\nReferences \n\n\n^ ICH GCP \n\n^ Common Terminology Criteria for Adverse Events \n\n\nExternal links \nClinicalTrials.gov from US National Library of Medicine\nICH Website\nFDA Website\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Adverse_event\">https:\/\/www.limswiki.org\/index.php\/Adverse_event<\/a>\n\t\t\t\t\tCategory: Healthcare termsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:47.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 467 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","a0550ad91421c65fcff8f1e3ca9b41d9_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Adverse_event skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Adverse event<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For the House episode, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adverse_Events\" title=\"Adverse Events\" rel=\"external_link\" target=\"_blank\">Adverse Events<\/a>.<\/div>\n\n<p>An <b>adverse event<\/b> (<b>AE<\/b>) is any untoward medical occurrence in a patient or clinical investigation subject administered a pharmaceutical product and which does not necessarily have a causal relationship with this treatment. An adverse event (AE) can therefore be any unfavourable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal (investigational) product, whether or not related to the medicinal (investigational) product.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>AEs in patients participating in clinical trials must be reported to the study sponsor and if required could be reported to local ethics committee . Adverse events categorized as \"serious\" ( results in death, illness requiring hospitalization, events deemed life-threatening, results in persistent or significant disability\/incapacity, a congenital anomaly\/birth defect or medically important condition) must be reported to the regulatory authorities immediately, whereas non-serious adverse events are merely documented in the annual summary sent to the regulatory authority.\n<\/p><p>The sponsor collects AE reports from the local researchers, and notifies all participating sites of the AEs at the other sites, as well as both the local investigators' and the sponsors' judgment of the seriousness of the AEs. This process allows the sponsor and all the local investigators access to a set of data that might suggest potential problems with the study treatment while the study is still ongoing.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types_of_adverse_events\">Types of adverse events<\/span><\/h2>\n<p>All clinical trials have the potential to produce AEs. AEs are classified as serious or non-serious; expected or unexpected; and study-related, possibly study-related, or not study-related.\n<\/p><p>For example, while a study that tests the effectiveness of a new blood pressure cuff for a period of 10 minutes might seem innocuous, the potential exists for the patient's skin to be irritated by the device. Patients in that study might also die during that 10-minute period. Both skin irritation and sudden death would be considered AEs. In this case, the skin irritation would be classified as not serious, unexpected, and possibly study-related. The death would be classified as serious and unexpected (unless the patient was already at death's door). The local researcher would use his\/her medical judgment to determine whether the death could have been related to the study device.\n<\/p><p>Both the skin irritation and the death are unexpected events, and should alert the researcher to the potential existence of a problem with the device (for instance, it could have malfunctioned and shocked the patient). The researcher would report these AEs to the local <a href=\"https:\/\/en.wikipedia.org\/wiki\/Institutional_Review_Board\" class=\"mw-redirect\" title=\"Institutional Review Board\" rel=\"external_link\" target=\"_blank\">Institutional Review Board<\/a> and to the sponsor, and await direction on whether to stop the study. If the researcher feels there is an imminent danger posed by the device, he or she can use medical discretion to stop patients from participating in the study.\n<\/p><p>An adverse event can also be declared in the normal treatment of a patient which is suspected of being caused by the medication being taken or a medical device used in the treatment of the patient.\n<\/p><p>In Australia, 'Adverse EVENT' refers generically to medical errors of all kinds, surgical, medical or nursing related. The most recent available official study (1995) indicated 18,000 deaths per year are a result of hospital care. The Medical Error Action Group is lobbying for legislation to improve the reporting of AEs and through quality control, minimize the needless deaths.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Reporting_of_adverse_events\">Reporting of adverse events<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monitoring_in_clinical_trials\" title=\"Monitoring in clinical trials\" rel=\"external_link\" target=\"_blank\">Monitoring in clinical trials<\/a><\/div>\n<p>Researchers participating in a clinical trial must report all adverse events to the drug regulatory authority of the respective country where the drug or device is to be registered [e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">Food and Drug Administration<\/a> (FDA) if it is US]. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Serious_adverse_event\" title=\"Serious adverse event\" rel=\"external_link\" target=\"_blank\">Serious AEs<\/a> must be reported immediately; minor AEs are 'bundled' by the sponsor and submitted later.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Grades_of_AE\">Grades of AE<\/span><\/h2>\n<p>Clinical trial results often report the number of grade 3 and grade 4 adverse events.\nGrades are defined:<sup id=\"rdp-ebb-cite_ref-ctcaev_2-0\" class=\"reference\"><a href=\"#cite_note-ctcaev-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<ul><li>Grade 1 Mild AE<\/li>\n<li>Grade 2 Moderate AE<\/li>\n<li>Grade 3 Severe AE<\/li>\n<li>Grade 4 Life-threatening or disabling AE<\/li>\n<li>Grade 5 Death related to AE<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Database_of_adverse_events\">Database of adverse events<\/span><\/h2>\n\n<p>The FDA provides a database for reporting of adverse events called the <i>Manufacturer and User Facility Device Experience Database<\/i> (MAUDE)[1]. The data consist of voluntary reports since June 1993, user facility reports since 1991, distributor reports since 1993, and manufacturer reports since August 1996, and is open for public view. Two private companies have also recently started providing access to analyzed adverse event information: Clarimed provides adverse event information for medical devices and AdverseEvents provides adverse event data for drugs.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_trial\" title=\"Clinical trial\" rel=\"external_link\" target=\"_blank\">Clinical trial<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Good_clinical_practice\" title=\"Good clinical practice\" rel=\"external_link\" target=\"_blank\">Good clinical practice<\/a> (GCP)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Data_monitoring_committee\" title=\"Data monitoring committee\" rel=\"external_link\" target=\"_blank\">Data monitoring committees<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Serious_adverse_event\" title=\"Serious adverse event\" rel=\"external_link\" target=\"_blank\">Serious adverse event<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Adverse_effect\" title=\"Adverse effect\" rel=\"external_link\" target=\"_blank\">Adverse effect<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Adverse_drug_reaction\" title=\"Adverse drug reaction\" rel=\"external_link\" target=\"_blank\">Adverse drug reaction<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pharmacovigilance\" title=\"Pharmacovigilance\" rel=\"external_link\" target=\"_blank\">Pharmacovigilance<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/EudraVigilance\" title=\"EudraVigilance\" rel=\"external_link\" target=\"_blank\">EudraVigilance<\/a> (European Union AE reporting and evaluating network)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_Trials_Directive\" title=\"Clinical Trials Directive\" rel=\"external_link\" target=\"_blank\">Clinical Trials Directive<\/a> (Directive 2001\/20\/EC by European Union)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Adverse_Event_Reporting_System\" title=\"Adverse Event Reporting System\" rel=\"external_link\" target=\"_blank\">Adverse Event Reporting System<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Yellow_Card_Scheme\" title=\"Yellow Card Scheme\" rel=\"external_link\" target=\"_blank\">Yellow Card Scheme<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">ICH GCP<\/span>\n<\/li>\n<li id=\"cite_note-ctcaev-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ctcaev_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ctep.cancer.gov\/protocolDevelopment\/electronic_applications\/docs\/ctcaev3.pdf\" target=\"_blank\">Common Terminology Criteria for Adverse Events<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.clinicaltrials.gov\/\" target=\"_blank\">ClinicalTrials.gov<\/a> from US <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Library_of_Medicine\" class=\"mw-redirect\" title=\"National Library of Medicine\" rel=\"external_link\" target=\"_blank\">National Library of Medicine<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ich.org\" target=\"_blank\">ICH Website<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/\" target=\"_blank\">FDA Website<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1329\nCached time: 20181129133127\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.104 seconds\nReal time usage: 0.156 seconds\nPreprocessor visited node count: 378\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 11309\/2097152 bytes\nTemplate argument size: 239\/2097152 bytes\nHighest expansion depth: 10\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 727\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.037\/10.000 seconds\nLua memory usage: 1.3 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 128.004 1 -total\n<\/p>\n<pre>37.49% 47.987 1 Template:Refimprove\n35.51% 45.455 2 Template:Ambox\n21.78% 27.880 1 Template:For\n12.87% 16.470 1 Template:Globalize\/US\n10.66% 13.643 1 Template:Div_col\n 9.49% 12.153 1 Template:Globalize\n 6.12% 7.837 1 Template:Reflist\n 6.02% 7.704 1 Template:Main\n 2.69% 3.448 2 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2234553-1!canonical and timestamp 20181129133127 and revision id 858201907\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Adverse_event\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214708\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.009 seconds\nReal time usage: 0.140 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 134.737 1 - wikipedia:Adverse_event\n100.00% 134.737 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8572-0!*!*!*!*!*!* and timestamp 20181217214708 and revision id 25000\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Adverse_event\">https:\/\/www.limswiki.org\/index.php\/Adverse_event<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","a0550ad91421c65fcff8f1e3ca9b41d9_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png"],"a0550ad91421c65fcff8f1e3ca9b41d9_timestamp":1545083228,"db384186b2f2a397cbd511159e88f7ba_type":"article","db384186b2f2a397cbd511159e88f7ba_title":"Venipuncture","db384186b2f2a397cbd511159e88f7ba_url":"https:\/\/www.limswiki.org\/index.php\/Venipuncture","db384186b2f2a397cbd511159e88f7ba_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tVenipuncture\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (October 2007) (Learn how and when to remove this template message)\n Venipuncture\nPlay media Video of a venipuncture\nIn medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of intravenous therapy or for blood sampling of venous blood. In healthcare, this procedure is performed by medical laboratory scientists, medical practitioners, some EMTs, paramedics, phlebotomists, dialysis technicians, and other nursing staff.[1] In veterinary medicine, the procedure is performed by veterinarians and veterinary technicians.\nIt is essential to follow a standard procedure for the collection of blood specimen to get the accurate laboratory results. Any kind of error in collection of blood or filing the test tubes may lead erroneous laboratory results.[2]\nVenipuncture is one of the most routinely performed invasive procedures and is carried out for any of five reasons: \n\nto obtain blood for diagnostic purposes;\nto monitor levels of blood components (Lavery & Ingram 2005);\nto administer therapeutic treatments including medications, nutrition, or chemotherapy;\nto remove blood due to excess levels of iron or erythrocytes (red blood cells); or\nto collect blood for later uses, mainly transfusion either in the donor or in another person.\nBlood analysis is an important diagnostic tool available to clinicians within healthcare.\nBlood is most commonly obtained from the superficial veins of the upper limb.[1] The median cubital vein, which lies within the cubital fossa anterior to the elbow, is close to the surface of the skin without many large nerves positioned nearby.\nMinute quantities of blood may be taken by fingersticks sampling and collected from infants by means of a heel stick or from scalp veins with a winged infusion needle.\nPhlebotomy (incision into a vein) is also the treatment of certain diseases such as hemochromatosis and primary and secondary polycythemia.\n\nContents \n\n1 Equipment \n\n1.1 Venipuncture with evacuated or vacuum tubes \n1.2 Additives and order of draw \n\n\n2 Venipuncture in children \n3 Venipuncture with needle and syringe \n4 Blood cultures \n5 Taking blood samples from animals \n6 Blood alcohol tests \n7 See also \n8 References \n9 External links \n\n\nEquipment \nThere are many ways in which blood can be drawn from a vein. The best method varies with the age of the patient, equipment available and tests required.\nMost blood collection in the US, UK, Canada and Hong Kong is done with an evacuated tube system, (two common systems are Vacutainer (Becton, Dickinson and company) and Vacuette (Greiner Bio-One). The equipment consists of a plastic adapter, a.k.a. tube or needle holder\/ hub, a hypodermic needle and a vacuum tube. Under certain circumstances, a syringe may be used, often with a butterfly needle, which is a plastic catheter attached to a short needle. In the developing world, the evacuated tube system is the preferred method of drawing blood\n\nVenipuncture with evacuated or vacuum tubes \n Vacutainer blood bottles\nGreiner Bio-One manufactured the first ever plastic evacuated blood collection tube in 1985 under the VACUETTE brand name. Today, many companies sell vacuum tubes as the patent for this device is now in the public domain. These tubes are manufactured with a specific volume of gas removed from the sealed tube. When a needle from a hub or transfer device is inserted into the stopper, the tube's vacuum automatically pulls in the required volume of blood.\nThe basic Evacuated Tube System (ETS) consists of a needle, a tube holder, and the evacuated tubes. The needle is attached to the tube holder by the phlebotomist prior to collection, or may come from the manufacturer as one unit. the needle protrudes through the end of the tube holder, and has a needle on each end. After first cleaning the venipuncture site and applying a tourniquet, the phlebotomist uncaps the needle attached to the tube holder, inserts the needle into the vein, then slides evacuated tubes into the tube holder, where the tube's stopper is pierced by the back end of the needle. The vacuum in the tube then automatically draws the needed blood directly from the patient's vein. Multiple vacuum tubes can be attached to and removed in turn from a single needle, allowing multiple samples to be obtained from a single procedure. This is possible due to the multiple sample sleeve, which is a flexible rubber fitting over the posterior end of the needle cannula which seals the needle until it is pushed out of the way. This keeps blood from freely draining out of the back of the needle inserted in the patient's vein, as each test tube is removed and the next impaled. Safety regulations require that needles come equipped with a sheath or safety device to cover the needle after the procedure to prevent accidental needle stick injury.\nFittings and adapters used to fill evacuated tubes from butterfly needle kits and syringes are also available.\nThere are several needle gauges for a phlebotomist to choose from. The most commonly used are as follows: a 21g (green top) needle, a 22g (black top) needle, a 21g (green label) butterfly needle, a 23g (blue label) butterfly needle, and a 25g (orange label) butterfly needle (however this needle is only used in pediatrics or extreme cases as it is so small that it can often result in hemolizing the blood sample). There are also a variety of tube and bottle sizes and volumes for different test requirements.[3]\n\nAdditives and order of draw \nThe test tubes in which blood is collected may contain one or more of several additives. In general, tests requiring whole blood call for blood samples collected in test tubes containing some form of the anticoagulant EDTA. EDTA chelates calcium to prevent clotting. EDTA is preferred for hematology tests because it does minimum damage to cell morphology. Sodium Citrate is the anticoagulant used in specimens collected for coagulation tests. The majority of chemistry and immunology tests are performed on serum, which is produced by clotting and then separating the blood specimen via centrifuge. These specimens are collected in either a non-additive tube or one containing a clotting activator. This clotting activator can interfere with some assays, and so a plain tube is recommended in these cases, but will delay testing. Tubes containing lithium heparin or sodium heparin are also commonly used for a variety of chemistry tests, as they do not require clotting and can be centrifuged immediately after collection. A combination of sodium fluoride and potassium oxalate is used for glucose tests, as these additives both prevent clotting and stop glycolosis, so that blood glucose levels are preserved after collection. another specialty tube is an opaque amber colored tube used to collect blood for light sensitive analytes, such as bilirubin.\nTest tubes are labeled with the additive they contain, but the stopper on each tube is color coded according to additive as well. While colors vary between manufacturers, stopper colors generally are associated with each additive as listed below. Because the additives from each tube can be left on the needle used to fill the tubes, they must be drawn in a specific order to ensure that cross contamination will not negatively affect testing of the samples if multiple tubes are to be drawn at once. The \"order of draw\" varies by collection method. Below in the order of draw generally required for the Evacuated Tube System (ETS) collection method are the most common tubes, listing additive and color:\n1. Blood cultures and sterile collections (culture bottles)\n2. Sodium citrate (light blue)\n3. No additive\/ Silica clot activator (red and black stripped or gold SST), (red)\n4. Lithium Heparin (Light Green PST)\n5. Sodium Heparin (green)\n6. K2 EDTA, K3 EDTA (Purple\/lavender), (pink), (white PPT)\n7. Sodium fluoride and potassium oxalate (grey)\n8. Tube for testing trace elements containing EDTA or clot activator or no additive (Navy\/royal blue)\n9. ACD (yellow) and any other tubes\n\nVenipuncture in children \nFurther information: Pain management in children\nUse of lidocaine iontophoresis is effective for reducing pain and alleviating distress during venipuncture in pediatric patients.[4] A needle-free powder lignocaine delivery system has been shown to decrease the pain of venipuncture in children.[5][6] Rapid dermal anesthesia can be achieved by local anesthetic infiltration, but it may evoke anxiety in children frightened by needles or distort the skin, making vascular access more difficult and increasing the risk of needle exposure to health care workers. Dermal anesthesia can also be achieved without needles by the topical application of local anesthetics or by lidocaine iontophoresis. By contrast, noninvasive dermal anesthesia can be established in 5\u201315 min without distorting underlying tissues by lidocaine iontophoresis, where a direct electric current facilitates dermal penetration of positively charged lidocaine molecules when placed under the positive electrode.\nOne study concluded that the iontophoretic administration of lidocaine was safe and effective in providing dermal anesthesia for venipuncture in children 6\u201317 years old. This technique may not be applicable to all children. Future studies may provide information on the minimum effective iontophoretic dose for dermal anesthesia in children and the comparison of the anesthetic efficacy and satisfaction of lidocaine iontophoresis with topical anesthetic creams and subcutaneous infiltration.[4]\nNon-pharmacological treatments for pain associated with venipuncture in children includes hypnosis and distraction. These treatments reduced self reported pain and when combined with cognitive-behavioural therapy (CBT) the reduction of pain was even greater. Other interventions have not been found to be effective and these are suggestion, blowing out air, and distraction with parent coaching did not differ from control for pain and distress.[7]\n\nVenipuncture with needle and syringe \nSome health care workers prefer to use a syringe-needle technique for venipuncture. Sarstedt manufactures a blood-drawing system S-Monovette that uses this principle. This method can be preferred on elderly patients, oncology patients, severely burned patients, obese patients or patients with unreliable or fragile veins. Because syringes are manually operated, the amount of suction applied may be easily controlled. This is particularly helpful with patients who have small veins that collapse under the suction of an evacuated tube. In children or other circumstances where the quantity of blood gained may be limited it can be helpful to know how much blood can be obtained before distributing it amongst the various additives that the laboratory will require.\n\nBlood cultures \nThere are times where a patient may require a blood culture collection. The culture will determine if the patient has pathogens in the blood. Normally blood is sterile. When drawing blood from cultures use a sterile solution such as Betadine rather than alcohol. This is done using sterile gloves, while not wiping away the surgical solution, touching the puncture site, or in any way compromising the sterile process. It is vital that the procedure is performed in as sterile a manner as possible as the persistent presence of skin commensals in blood cultures could indicate endocarditis but they are most often found as contaminants. \nIt is encouraged to use an abrasive method of skin preparation. This removes the upper layers of dead skin cells along with their contaminating bacteria. Povidone-iodine has traditionally been used but in the UK a 2% chlorhexidine in 70% ethanol or isopropyl alcohol solution is preferred and time must be allowed for it to dry. The tops of any containers used when drawing a blood culture should also be disinfected using a similar solution. Some labs will actively discourage iodine use where iodine is thought to degrade the rubber stopper through which blood enters the bottle, thus allowing contaminates to enter the container.\nThe blood is collected into special transport bottles, which are like vacuum tubes but shaped differently. The blood culture bottle contains transport media to preserve any microorganisms present while they are being transported to the laboratory for cultures. Because it is unknown whether the pathogens are anaerobic (living without oxygen) or aerobic (living with oxygen), blood is collected to test for both. The aerobic bottle is filled first, and then the anaerobic bottle is filled. However, if the collection is performed using a syringe, the anaerobic bottle is filled first. If a butterfly collection kit is used, the aerobic bottle is filled first, so that any air in the tubing is released into the oxygen-containing bottle.\nSpecially designed blood culture collection bottles eliminate the need for either the syringe or butterfly collection method. These specially designed bottles have long necks that fit into the evacuated tubes holders that are use for regular venipuncture collection. These bottles also allow for collection of other blood specimens via evacuated tubes, to be collected without additional venipuncture.\nThe amount of blood that is collected is critical for the optimal recovery of microorganisms. Up to 10mL of blood is typical, but can vary according to the recommends of the manufacturer of the collection bottle. Collection from infants and children are 1 to 5 mL. If too little blood is collected, the ratio of blood-to-nutrient broth will inhibit the growth of microorganisms. If too much blood is collected from the patient, the patient risks a hospital-induced anemia and the ratio of blood-to-nutrient broth will tilt in the opposite direction, which also is not conductive to optimal growth.\nThe bottles are then incubated in specialized units for 24 hours before a lab technician studies and\/or tests it. This step allows the very small numbers of bacteria (potentially 1 or 2 organisms) to multiply to a level which is sufficient for identification +\/-antibiotic resistance testing. Modern blood culture bottles have an indicator in the base which changes color in the presence of bacterial growth and can be read automatically by machine. (For this reason the barcoded stickers found on these bottles should not be removed as they are used by the laboratorys automated systems.)\n\nTaking blood samples from animals \nBlood samples from living laboratory animals may be collected using following methods:[8][9]\n\nBlood collection not requiring anesthesia:\nSaphenous vein (rat, mice, guinea pig)\nDorsal pedal vein (rat, mice)\nBlood collection requiring anesthesia (local\/general anesthesia):\nTail vein (rat, mice)\nTail snip (mice)\nOrbital sinus (rat, mice)[10]\nJugular vein (rat, mice)\nTemporary cannula (rat, mice)\nBlood vessel cannulation (guinea pig, ferret)\nTarsal vein (guinea pig)\nMarginal ear vein or artery (rabbit)\nTerminal procedure:\nCardiac puncture (rat, mice, guinea pig, rabbit, ferret)\nOrbital sinus (rat, mice)\nPosterior vena cava (rat, mice)\nThe volume of the blood sample collection is very important in experimental animals. All nonterminal blood collection without replacement of fluids is limited up to 10% of total circulating blood volume in healthy, normal, adult animals on a single occasion and collection may be repeated after three to four weeks. In case repeated blood samples are required at short intervals, a maximum of 0.6 ml\/kg\/day or 1.0% of an animal's total blood volume can be removed every 24 hours. The estimated blood volume in adult animals is 55 to 70 ml\/kg body weight. Care should be taken for older and obese animals. If blood collection volume exceeds more than 10% of total blood volume, fluid replacement may be required. Lactated Ringer's solution (LRS) is recommended as the best fluid replacement by National Institutes of Health (NIH). If the volume of blood collection exceeds more than 30% of the total circulatory blood volume, adequate care should be taken so that the animal does not suffer from hypovolemia.[9]\n\nBlood alcohol tests \nIt is generally not advisable to use isopropyl alcohol to cleanse the venipuncture site when obtaining a specimen for a blood alcohol test. This has been related largely to the potential legal implications associated with use of alcohol based cleaners that could theoretically impact analysis. Numerous police alcohol collection kits have been marketed that incorporate a sodium fluoride\/potassium oxalate preservative and non-alcohol based cleansing agents to ensure proper collection. Using soap and hot water or a povidone iodine swab are advisable alternatives to isopropyl alcohol in this case.\n\nSee also \n\nArterial blood is taken from an artery instead of a vein.\nBlood donation\nFingerstick\nNeonatal heel prick\nPhlebotomist\nVacutainer\n\nReferences \n\n\n^ a b Higgins, Dan (28 September 2004). \"Venepuncture\". Nursing Times. 100 (39): 30. \n\n^ Dg, Dayyal. \"PROCEDURES FOR THE COLLECTION OF BLOOD FOR HEMOTOLOGICAL INVESTIGATIONS\". BioScience Pakistan. BioScience Pakistan. ISSN 2521-5760. \n\n^ Perry, Sally (2007). \"Ask the Lab: Hemolyze blood specimens\". Nursing.advanceweb.com. Retrieved 2013-12-29 . \n\n^ a b Rose, John B.; Galinkin, Jeffrey L.; Jantzen, Ellen C.; Chiavacci, Rosetta M. (2002). \"A Study of Lidocaine Iontophoresis for Pediatric Venipuncture\". Anesthesia & Analgesia. 94 (4): 867. doi:10.1097\/00000539-200204000-00017. \n\n^ Lacroix, Helene (2008-10-01). \"A needle-free powder lignocaine delivery system reduced the pain of venipuncture in childrenCommentary\". Evidence-Based Nursing. 11 (4): 106\u2013106. doi:10.1136\/ebn.11.4.106. ISSN 1367-6539. PMID 18815318. \n\n^ Ltd, BMJ Publishing Group Ltd and RCN Publishing Company (2006-01-01). \"Liposomal lidocaine improved intravenous cannulation success rates in children\". Evidence-Based Nursing. 9 (1): 10\u201310. doi:10.1136\/ebn.9.1.10. ISSN 1367-6539. PMID 16437788. \n\n^ Ltd, BMJ Publishing Group Ltd and RCN Publishing Company (2007-07-01). \"Review: distraction, hypnosis, and combined cognitive-behavioural interventions reduce needle related pain and distress in children and adolescents\". Evidence-Based Nursing. 10 (3): 75\u201375. doi:10.1136\/ebn.10.3.75. ISSN 1367-6539. PMID 17596380. \n\n^ Hoff, J. (2000). \"Methods of Blood Collection in the Mouse\" (PDF) . Lab Animal. 29 (10): 47\u201353. \n\n^ a b Parasuraman, S; Raveendran, R; Kesavan, R (2010). \"Blood sample collection in small laboratory animals\". Journal of Pharmacology and Pharmacotherapeutics. 1 (2): 87\u201393. doi:10.4103\/0976-500X.72350. PMC 3043327 . PMID 21350616. \n\n^ Parasuraman S, Zhen KM, Raveendran R. Retro-orbital Blood Sample Collection in Rats-a Video Article. PTB Reports 1 (2), 37-40|DOI : 10.5530\/PTB.1.2.1|Available in http:\/\/www.ptbreports.org\/article\/41 \n\n\nExternal links \nPhlebotomy details\nvteVascular surgery ICD-9-CM V3 38\u201339, ICD-10-PCS 03\u20136Vascular and \r\nEndovascular surgeryArterial disease\nVascular bypass\nAngioplasty\nAtherectomy\nEndarterectomy\nCarotid endarterectomy\nStenting\nCarotid stenting\nVenous disease\nAmbulatory phlebectomy\nLaser surgery\nSclerotherapy\nVein stripping\nArterial and venous access\nVenous cutdown\nArteriotomy\nPhlebotomy\nAortic aneurysm \/ dissection:\nEndovascular aneurysm repair\nOpen aortic surgery\nOther\nCardiopulmonary bypass\nCardioplegia\nExtracorporeal membrane oxygenation\nVascular access\nRevascularization\nFirst rib resection\nSeldinger technique\nVascular snare\nMedical imagingAngiography\nDigital subtraction angiography\nCerebral angiography\nAortography\nFluorescein angiography\nRadionuclide angiography\nMagnetic resonance angiography\nVenography\nPortography\nImpedance phlebography\nUltrasound\nIntravascular ultrasound\nCarotid ultrasonography\nOther diagnostic\nAngioscopy\nAnkle brachial pressure index\nToe pressure\nTilt table test\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Venipuncture\">https:\/\/www.limswiki.org\/index.php\/Venipuncture<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog 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id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Venipuncture<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Venipuncture_using_a_BD_Vacutainer.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9b\/Venipuncture_using_a_BD_Vacutainer.JPG\/170px-Venipuncture_using_a_BD_Vacutainer.JPG\" width=\"170\" height=\"227\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Venipuncture_using_a_BD_Vacutainer.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Venipuncture<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><div id=\"rdp-ebb-mwe_player_0\" class=\"PopUpMediaTransform\" style=\"width:220px;\" videopayload=\"<div class="mediaContainer" style="width:480px"><video id="mwe_player_1" poster="\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/480px--Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.jpg" controls="" preload="none" autoplay="" style="width:480px;height:480px" class="kskin" data-durationhint="15.072" data-startoffset="0" data-mwtitle="Video_of_venipuncture_(blood_draw_or_collection)_using_the_BD_Vacutainer_product..webm" data-mwprovider="wikimediacommons"><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.480p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="SD VP9 (480P)" data-shorttitle="VP9 480P" data-transcodekey="480p.vp9.webm" data-width="480" data-height="480" data-bandwidth="609944" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.480p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="SD WebM (480P)" data-shorttitle="WebM 480P" data-transcodekey="480p.webm" data-width="480" data-height="480" data-bandwidth="1077240" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Original WebM file, 640 \u00d7 640 (1.25 Mbps)" data-shorttitle="WebM source" data-width="640" data-height="640" data-bandwidth="1246934" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.120p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Lowest bandwidth VP9 (120P)" data-shorttitle="VP9 120P" data-transcodekey="120p.vp9.webm" data-width="120" data-height="120" data-bandwidth="172872" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.160p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Low bandwidth WebM (160P)" data-shorttitle="WebM 160P" data-transcodekey="160p.webm" data-width="160" data-height="160" data-bandwidth="201928" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.180p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Low bandwidth VP9 (180P)" data-shorttitle="VP9 180P" data-transcodekey="180p.vp9.webm" data-width="180" data-height="180" data-bandwidth="222392" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.240p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Small VP9 (240P)" data-shorttitle="VP9 240P" data-transcodekey="240p.vp9.webm" data-width="240" data-height="240" data-bandwidth="254880" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.240p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Small WebM (240P)" data-shorttitle="WebM 240P" data-transcodekey="240p.webm" data-width="240" data-height="240" data-bandwidth="316408" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.360p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="VP9 (360P)" data-shorttitle="VP9 360P" data-transcodekey="360p.vp9.webm" data-width="360" data-height="360" data-bandwidth="361944" data-framerate="60"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.360p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="WebM (360P)" data-shorttitle="WebM 360P" data-transcodekey="360p.webm" data-width="360" data-height="360" data-bandwidth="573392" data-framerate="60"\/><\/video><\/div>\"><img alt=\"File:Video of venipuncture (blood draw or collection) using the BD Vacutainer product..webm\" style=\"width:220px;height:220px\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\/220px--Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.jpg\" \/><a href=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/1\/13\/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm\" title=\"Play media\" target=\"_blank\" rel=\"external_link\"><span class=\"play-btn-large\"><span class=\"mw-tmh-playtext\">Play media<\/span><\/span><\/a><\/div> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Video_of_venipuncture_(blood_draw_or_collection)_using_the_BD_Vacutainer_product..webm\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Video of a venipuncture<\/div><\/div><\/div>\n<p>In medicine, <b>venipuncture<\/b> or <b>venepuncture<\/b> is the process of obtaining intravenous access for the purpose of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy\" title=\"Intravenous therapy\" rel=\"external_link\" target=\"_blank\">intravenous therapy<\/a> or for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_sampling\" class=\"mw-redirect\" title=\"Blood sampling\" rel=\"external_link\" target=\"_blank\">blood sampling<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">venous<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood\" title=\"Blood\" rel=\"external_link\" target=\"_blank\">blood<\/a>. In healthcare, this procedure is performed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_Laboratory_Scientist\" class=\"mw-redirect\" title=\"Medical Laboratory Scientist\" rel=\"external_link\" target=\"_blank\">medical laboratory scientists<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physician\" title=\"Physician\" rel=\"external_link\" target=\"_blank\">medical practitioners<\/a>, some <a href=\"https:\/\/en.wikipedia.org\/wiki\/EMTs\" class=\"mw-redirect\" title=\"EMTs\" rel=\"external_link\" target=\"_blank\">EMTs<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paramedics\" class=\"mw-redirect\" title=\"Paramedics\" rel=\"external_link\" target=\"_blank\">paramedics<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phlebotomist\" class=\"mw-redirect\" title=\"Phlebotomist\" rel=\"external_link\" target=\"_blank\">phlebotomists<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dialysis\" title=\"Dialysis\" rel=\"external_link\" target=\"_blank\">dialysis<\/a> technicians, and other nursing staff.<sup id=\"rdp-ebb-cite_ref-NT_2004_1-0\" class=\"reference\"><a href=\"#cite_note-NT_2004-1\" rel=\"external_link\">[1]<\/a><\/sup> In veterinary medicine, the procedure is performed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Veterinarians\" class=\"mw-redirect\" title=\"Veterinarians\" rel=\"external_link\" target=\"_blank\">veterinarians<\/a> and veterinary technicians.\n<\/p><p>It is essential to follow a standard procedure for the collection of blood specimen to get the accurate laboratory results. Any kind of error in collection of blood or filing the test tubes may lead erroneous laboratory results.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>Venipuncture is one of the most routinely performed invasive procedures and is carried out for any of five reasons: \n<\/p>\n<ol><li>to obtain blood for diagnostic purposes;<\/li>\n<li>to monitor levels of blood components (Lavery & Ingram 2005);<\/li>\n<li>to administer therapeutic treatments including medications, nutrition, or chemotherapy;<\/li>\n<li>to remove blood due to excess levels of iron or erythrocytes (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Red_blood_cell\" title=\"Red blood cell\" rel=\"external_link\" target=\"_blank\">red blood cells<\/a>); or<\/li>\n<li>to collect blood for later uses, mainly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_transfusion\" title=\"Blood transfusion\" rel=\"external_link\" target=\"_blank\">transfusion<\/a> either <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autologous_blood_transfusion\" class=\"mw-redirect\" title=\"Autologous blood transfusion\" rel=\"external_link\" target=\"_blank\">in the donor<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_donation\" title=\"Blood donation\" rel=\"external_link\" target=\"_blank\">in another person<\/a>.<\/li><\/ol>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_analysis\" class=\"mw-redirect\" title=\"Blood analysis\" rel=\"external_link\" target=\"_blank\">Blood analysis<\/a> is an important diagnostic tool available to clinicians within healthcare.\n<\/p><p>Blood is most commonly obtained from the superficial veins of the upper limb.<sup id=\"rdp-ebb-cite_ref-NT_2004_1-1\" class=\"reference\"><a href=\"#cite_note-NT_2004-1\" rel=\"external_link\">[1]<\/a><\/sup> The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Median_cubital_vein\" title=\"Median cubital vein\" rel=\"external_link\" target=\"_blank\">median cubital vein<\/a>, which lies within the cubital fossa anterior to the elbow, is close to the surface of the skin without many large nerves positioned nearby.\n<\/p><p>Minute quantities of blood may be taken by fingersticks sampling and collected from infants by means of a heel stick or from scalp veins with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Winged_infusion_needle\" class=\"mw-redirect\" title=\"Winged infusion needle\" rel=\"external_link\" target=\"_blank\">winged infusion needle<\/a>.\n<\/p><p>Phlebotomy (incision into a vein) is also the treatment of certain diseases such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemochromatosis\" class=\"mw-redirect\" title=\"Hemochromatosis\" rel=\"external_link\" target=\"_blank\">hemochromatosis<\/a> and primary and secondary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polycythemia\" title=\"Polycythemia\" rel=\"external_link\" target=\"_blank\">polycythemia<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Equipment\">Equipment<\/span><\/h2>\n<p>There are many ways in which blood can be drawn from a vein. The best method varies with the age of the patient, equipment available and tests required.\n<\/p><p>Most blood collection in the US, UK, Canada and Hong Kong is done with an evacuated tube system, (two common systems are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vacutainer\" title=\"Vacutainer\" rel=\"external_link\" target=\"_blank\">Vacutainer<\/a> (Becton, Dickinson and company) and <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.gbo.com\" target=\"_blank\">Vacuette<\/a> (Greiner Bio-One). The equipment consists of a plastic adapter, a.k.a. tube or needle holder\/ hub, a hypodermic needle and a vacuum tube. Under certain circumstances, a syringe may be used, often with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Butterfly_needle\" class=\"mw-redirect\" title=\"Butterfly needle\" rel=\"external_link\" target=\"_blank\">butterfly needle<\/a>, which is a plastic catheter attached to a short needle. In the developing world, the evacuated tube system is the preferred method of drawing blood\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Venipuncture_with_evacuated_or_vacuum_tubes\">Venipuncture with evacuated or vacuum tubes<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vacutainer_blood_bottles.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ee\/Vacutainer_blood_bottles.jpg\/220px-Vacutainer_blood_bottles.jpg\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vacutainer_blood_bottles.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Vacutainer blood bottles<\/div><\/div><\/div>\n<p>Greiner Bio-One manufactured the first ever plastic evacuated blood collection tube in 1985 under the VACUETTE brand name. Today, many companies sell vacuum tubes as the patent for this device is now in the public domain. These tubes are manufactured with a specific volume of gas removed from the sealed tube. When a needle from a hub or transfer device is inserted into the stopper, the tube's vacuum automatically pulls in the required volume of blood.\n<\/p><p>The basic Evacuated Tube System (ETS) consists of a needle, a tube holder, and the evacuated tubes. The needle is attached to the tube holder by the phlebotomist prior to collection, or may come from the manufacturer as one unit. the needle protrudes through the end of the tube holder, and has a needle on each end. After first cleaning the venipuncture site and applying a tourniquet, the phlebotomist uncaps the needle attached to the tube holder, inserts the needle into the vein, then slides evacuated tubes into the tube holder, where the tube's stopper is pierced by the back end of the needle. The vacuum in the tube then automatically draws the needed blood directly from the patient's vein. Multiple vacuum tubes can be attached to and removed in turn from a single needle, allowing multiple samples to be obtained from a single procedure. This is possible due to the multiple sample sleeve, which is a flexible rubber fitting over the posterior end of the needle cannula which seals the needle until it is pushed out of the way. This keeps blood from freely draining out of the back of the needle inserted in the patient's vein, as each test tube is removed and the next impaled. Safety regulations require that needles come equipped with a sheath or safety device to cover the needle after the procedure to prevent accidental needle stick injury.\n<\/p><p>Fittings and adapters used to fill evacuated tubes from butterfly needle kits and syringes are also available.\n<\/p><p>There are several needle gauges for a phlebotomist to choose from. The most commonly used are as follows: a 21g (green top) needle, a 22g (black top) needle, a 21g (green label) butterfly needle, a 23g (blue label) butterfly needle, and a 25g (orange label) butterfly needle (however this needle is only used in pediatrics or extreme cases as it is so small that it can often result in hemolizing the blood sample). There are also a variety of tube and bottle sizes and volumes for different test requirements.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Additives_and_order_of_draw\">Additives and order of draw<\/span><\/h3>\n<p>The test tubes in which blood is collected may contain one or more of several additives. In general, tests requiring whole blood call for blood samples collected in test tubes containing some form of the anticoagulant <a href=\"https:\/\/en.wikipedia.org\/wiki\/EDTA\" class=\"mw-redirect\" title=\"EDTA\" rel=\"external_link\" target=\"_blank\">EDTA<\/a>. EDTA <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chelation\" title=\"Chelation\" rel=\"external_link\" target=\"_blank\">chelates<\/a> calcium to prevent clotting. EDTA is preferred for hematology tests because it does minimum damage to cell morphology. Sodium Citrate is the anticoagulant used in specimens collected for coagulation tests. The majority of chemistry and immunology tests are performed on serum, which is produced by clotting and then separating the blood specimen via centrifuge. These specimens are collected in either a non-additive tube or one containing a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulation\" title=\"Coagulation\" rel=\"external_link\" target=\"_blank\">clotting<\/a> activator. This clotting activator can interfere with some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Assay\" title=\"Assay\" rel=\"external_link\" target=\"_blank\">assays<\/a>, and so a plain tube is recommended in these cases, but will delay testing. Tubes containing lithium heparin or sodium heparin are also commonly used for a variety of chemistry tests, as they do not require clotting and can be centrifuged immediately after collection. A combination of sodium fluoride and potassium oxalate is used for glucose tests, as these additives both prevent clotting and stop glycolosis, so that blood glucose levels are preserved after collection. another specialty tube is an opaque amber colored tube used to collect blood for light sensitive analytes, such as bilirubin.\n<\/p><p>Test tubes are labeled with the additive they contain, but the stopper on each tube is color coded according to additive as well. While colors vary between manufacturers, stopper colors generally are associated with each additive as listed below. Because the additives from each tube can be left on the needle used to fill the tubes, they must be drawn in a specific order to ensure that cross contamination will not negatively affect testing of the samples if multiple tubes are to be drawn at once. The \"order of draw\" varies by collection method. Below in the order of draw generally required for the Evacuated Tube System (ETS) collection method are the most common tubes, listing additive and color:\n<\/p><p>1. Blood cultures and sterile collections (culture bottles)\n<\/p><p>2. Sodium citrate (light blue)\n<\/p><p>3. No additive\/ Silica clot activator (red and black stripped or gold SST), (red)\n<\/p><p>4. Lithium Heparin (Light Green PST)\n<\/p><p>5. Sodium Heparin (green)\n<\/p><p>6. K2 EDTA, K3 EDTA (Purple\/lavender), (pink), (white PPT)\n<\/p><p>7. Sodium fluoride and potassium oxalate (grey)\n<\/p><p>8. Tube for testing trace elements containing EDTA or clot activator or no additive (Navy\/royal blue)\n<\/p><p>9. ACD (yellow) and any other tubes\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Venipuncture_in_children\">Venipuncture in children<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain_management_in_children\" title=\"Pain management in children\" rel=\"external_link\" target=\"_blank\">Pain management in children<\/a><\/div>\n<p>Use of lidocaine <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iontophoresis\" title=\"Iontophoresis\" rel=\"external_link\" target=\"_blank\">iontophoresis<\/a> is effective for reducing pain and alleviating distress during venipuncture in pediatric patients.<sup id=\"rdp-ebb-cite_ref-rose_4-0\" class=\"reference\"><a href=\"#cite_note-rose-4\" rel=\"external_link\">[4]<\/a><\/sup> A needle-free powder <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lidocaine\" title=\"Lidocaine\" rel=\"external_link\" target=\"_blank\">lignocaine<\/a> delivery system has been shown to decrease the pain of venipuncture in children.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> Rapid dermal anesthesia can be achieved by local anesthetic infiltration, but it may evoke anxiety in children frightened by needles or distort the skin, making vascular access more difficult and increasing the risk of needle exposure to health care workers. Dermal anesthesia can also be achieved without needles by the topical application of local anesthetics or by lidocaine iontophoresis. By contrast, noninvasive dermal anesthesia can be established in 5\u201315 min without distorting underlying tissues by lidocaine iontophoresis, where a direct electric current facilitates dermal penetration of positively charged lidocaine molecules when placed under the positive electrode.\n<\/p><p>One study concluded that the iontophoretic administration of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lidocaine\" title=\"Lidocaine\" rel=\"external_link\" target=\"_blank\">lidocaine<\/a> was safe and effective in providing dermal anesthesia for venipuncture in children 6\u201317 years old. This technique may not be applicable to all children. Future studies may provide information on the minimum effective iontophoretic dose for dermal anesthesia in children and the comparison of the anesthetic efficacy and satisfaction of lidocaine iontophoresis with topical anesthetic creams and subcutaneous infiltration.<sup id=\"rdp-ebb-cite_ref-rose_4-1\" class=\"reference\"><a href=\"#cite_note-rose-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>Non-pharmacological treatments for pain associated with venipuncture in children includes <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypnosis\" title=\"Hypnosis\" rel=\"external_link\" target=\"_blank\">hypnosis<\/a> and distraction. These treatments reduced self reported pain and when combined with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cognitive_behavioral_therapy\" title=\"Cognitive behavioral therapy\" rel=\"external_link\" target=\"_blank\">cognitive-behavioural therapy<\/a> (CBT) the reduction of pain was even greater. Other interventions have not been found to be effective and these are suggestion, blowing out air, and distraction with parent coaching did not differ from control for pain and distress.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Venipuncture_with_needle_and_syringe\">Venipuncture with needle and syringe<\/span><\/h2>\n<p>Some health care workers prefer to use a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Syringe\" title=\"Syringe\" rel=\"external_link\" target=\"_blank\">syringe<\/a>-needle technique for venipuncture. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sarstedt\" title=\"Sarstedt\" rel=\"external_link\" target=\"_blank\">Sarstedt<\/a> manufactures a blood-drawing system that uses this principle. This method can be preferred on elderly patients, oncology patients, severely burned patients, obese patients or patients with unreliable or fragile veins. Because syringes are manually operated, the amount of suction applied may be easily controlled. This is particularly helpful with patients who have small veins that collapse under the suction of an evacuated tube. In children or other circumstances where the quantity of blood gained may be limited it can be helpful to know how much blood can be obtained before distributing it amongst the various additives that the laboratory will require.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Blood_cultures\">Blood cultures<\/span><\/h2>\n<p>There are times where a patient may require a blood culture collection. The culture will determine if the patient has pathogens in the blood. Normally blood is sterile. When drawing blood from cultures use a sterile solution such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Betadine\" class=\"mw-redirect\" title=\"Betadine\" rel=\"external_link\" target=\"_blank\">Betadine<\/a> rather than <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alcohol\" title=\"Alcohol\" rel=\"external_link\" target=\"_blank\">alcohol<\/a>. This is done using sterile gloves, while not wiping away the surgical solution, touching the puncture site, or in any way compromising the sterile process. It is vital that the procedure is performed in as sterile a manner as possible as the persistent presence of skin <a href=\"https:\/\/en.wikipedia.org\/wiki\/Commensal\" class=\"mw-redirect\" title=\"Commensal\" rel=\"external_link\" target=\"_blank\">commensals<\/a> in blood cultures could indicate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endocarditis\" title=\"Endocarditis\" rel=\"external_link\" target=\"_blank\">endocarditis<\/a> but they are most often found as contaminants. \nIt is encouraged to use an abrasive method of skin preparation. This removes the upper layers of dead skin cells along with their contaminating bacteria. Povidone-iodine has traditionally been used but in the UK a 2% <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chlorhexidine\" title=\"Chlorhexidine\" rel=\"external_link\" target=\"_blank\">chlorhexidine<\/a> in 70% ethanol or isopropyl alcohol solution is preferred and time must be allowed for it to dry. The tops of any containers used when drawing a blood culture should also be disinfected using a similar solution. Some labs will actively discourage iodine use where iodine is thought to degrade the rubber stopper through which blood enters the bottle, thus allowing contaminates to enter the container.\n<\/p><p>The blood is collected into special transport bottles, which are like vacuum tubes but shaped differently. The blood culture bottle contains transport media to preserve any microorganisms present while they are being transported to the laboratory for cultures. Because it is unknown whether the pathogens are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anaerobic_organism\" title=\"Anaerobic organism\" rel=\"external_link\" target=\"_blank\">anaerobic<\/a> (living without oxygen) or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aerobic_organism\" title=\"Aerobic organism\" rel=\"external_link\" target=\"_blank\">aerobic<\/a> (living with oxygen), blood is collected to test for both. The aerobic bottle is filled first, and then the anaerobic bottle is filled. However, if the collection is performed using a syringe, the anaerobic bottle is filled first. If a butterfly collection kit is used, the aerobic bottle is filled first, so that any air in the tubing is released into the oxygen-containing bottle.\n<\/p><p>Specially designed blood culture collection bottles eliminate the need for either the syringe or butterfly collection method. These specially designed bottles have long necks that fit into the evacuated tubes holders that are use for regular venipuncture collection. These bottles also allow for collection of other blood specimens via evacuated tubes, to be collected without additional venipuncture.\n<\/p><p>The amount of blood that is collected is critical for the optimal recovery of microorganisms. Up to 10mL of blood is typical, but can vary according to the recommends of the manufacturer of the collection bottle. Collection from infants and children are 1 to 5 mL. If too little blood is collected, the ratio of blood-to-nutrient broth will inhibit the growth of microorganisms. If too much blood is collected from the patient, the patient risks a hospital-induced anemia and the ratio of blood-to-nutrient broth will tilt in the opposite direction, which also is not conductive to optimal growth.\n<\/p><p>The bottles are then incubated in specialized units for 24 hours before a lab technician studies and\/or tests it. This step allows the very small numbers of bacteria (potentially 1 or 2 organisms) to multiply to a level which is sufficient for identification +\/-antibiotic resistance testing. Modern blood culture bottles have an indicator in the base which changes color in the presence of bacterial growth and can be read automatically by machine. (For this reason the barcoded stickers found on these bottles should not be removed as they are used by the laboratorys automated systems.)\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Taking_blood_samples_from_animals\">Taking blood samples from animals<\/span><\/h2>\n<p>Blood samples from living laboratory animals may be collected using following methods:<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Parasuraman2010_9-0\" class=\"reference\"><a href=\"#cite_note-Parasuraman2010-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<ul><li>Blood collection not requiring anesthesia:\n<ul><li>Saphenous vein (rat, mice, guinea pig)<\/li>\n<li>Dorsal pedal vein (rat, mice)<\/li><\/ul><\/li>\n<li>Blood collection requiring anesthesia (local\/general anesthesia):\n<ul><li>Tail vein (rat, mice)<\/li>\n<li>Tail snip (mice)<\/li>\n<li>Orbital sinus (rat, mice)<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li>Jugular vein (rat, mice)<\/li>\n<li>Temporary cannula (rat, mice)<\/li>\n<li>Blood vessel cannulation (guinea pig, ferret)<\/li>\n<li>Tarsal vein (guinea pig)<\/li>\n<li>Marginal ear vein or artery (rabbit)<\/li><\/ul><\/li>\n<li>Terminal procedure:\n<ul><li>Cardiac puncture (rat, mice, guinea pig, rabbit, ferret)<\/li>\n<li>Orbital sinus (rat, mice)<\/li>\n<li>Posterior vena cava (rat, mice)<\/li><\/ul><\/li><\/ul>\n<p>The volume of the blood sample collection is very important in experimental animals. All nonterminal blood collection without replacement of fluids is limited up to 10% of total circulating blood volume in healthy, normal, adult animals on a single occasion and collection may be repeated after three to four weeks. In case repeated blood samples are required at short intervals, a maximum of 0.6 ml\/kg\/day or 1.0% of an animal's total blood volume can be removed every 24 hours. The estimated blood volume in adult animals is 55 to 70 ml\/kg body weight. Care should be taken for older and obese animals. If blood collection volume exceeds more than 10% of total blood volume, fluid replacement may be required. Lactated Ringer's solution (LRS) is recommended as the best fluid replacement by National Institutes of Health (NIH). If the volume of blood collection exceeds more than 30% of the total circulatory blood volume, adequate care should be taken so that the animal does not suffer from hypovolemia.<sup id=\"rdp-ebb-cite_ref-Parasuraman2010_9-1\" class=\"reference\"><a href=\"#cite_note-Parasuraman2010-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Blood_alcohol_tests\">Blood alcohol tests<\/span><\/h2>\n<p>It is generally not advisable to use <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isopropyl_alcohol\" title=\"Isopropyl alcohol\" rel=\"external_link\" target=\"_blank\">isopropyl alcohol<\/a> to cleanse the venipuncture site when obtaining a specimen for a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_alcohol\" class=\"mw-redirect\" title=\"Blood alcohol\" rel=\"external_link\" target=\"_blank\">blood alcohol<\/a> test. This has been related largely to the potential legal implications associated with use of alcohol based cleaners that could theoretically impact analysis. Numerous police alcohol collection kits have been marketed that incorporate a sodium fluoride\/potassium oxalate preservative and non-alcohol based cleansing agents to ensure proper collection. Using soap and hot water or a povidone iodine swab are advisable alternatives to isopropyl alcohol in this case.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arterial_blood\" title=\"Arterial blood\" rel=\"external_link\" target=\"_blank\">Arterial blood<\/a> is taken from an artery instead of a vein.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_donation\" title=\"Blood donation\" rel=\"external_link\" target=\"_blank\">Blood donation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fingerstick\" title=\"Fingerstick\" rel=\"external_link\" target=\"_blank\">Fingerstick<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Neonatal_heel_prick\" title=\"Neonatal heel prick\" rel=\"external_link\" target=\"_blank\">Neonatal heel prick<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Phlebotomist\" class=\"mw-redirect\" title=\"Phlebotomist\" rel=\"external_link\" target=\"_blank\">Phlebotomist<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vacutainer\" title=\"Vacutainer\" rel=\"external_link\" target=\"_blank\">Vacutainer<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-NT_2004-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-NT_2004_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-NT_2004_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Higgins, Dan (28 September 2004). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nursingtimes.net\/clinical-archive\/infection-control\/venepuncture\/204148.article\" target=\"_blank\">\"Venepuncture\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nursing_Times\" title=\"Nursing Times\" rel=\"external_link\" target=\"_blank\">Nursing Times<\/a><\/i>. <b>100<\/b> (39): 30.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nursing+Times&rft.atitle=Venepuncture&rft.volume=100&rft.issue=39&rft.pages=30&rft.date=2004-09-28&rft.aulast=Higgins&rft.aufirst=Dan&rft_id=https%3A%2F%2Fwww.nursingtimes.net%2Fclinical-archive%2Finfection-control%2Fvenepuncture%2F204148.article&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Dg, Dayyal. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.bioscience.com.pk\/topics\/hemotology\/item\/796-procedures-for-the-collection-of-blood-for-hemotological-investigations\" target=\"_blank\">\"PROCEDURES FOR THE COLLECTION OF BLOOD FOR HEMOTOLOGICAL INVESTIGATIONS\"<\/a>. <i>BioScience Pakistan<\/i>. BioScience Pakistan. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2521-5760\" target=\"_blank\">2521-5760<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=BioScience+Pakistan&rft.atitle=PROCEDURES+FOR+THE+COLLECTION+OF+BLOOD+FOR+HEMOTOLOGICAL+INVESTIGATIONS&rft.issn=2521-5760&rft.aulast=Dg&rft.aufirst=Dayyal&rft_id=https%3A%2F%2Fwww.bioscience.com.pk%2Ftopics%2Fhemotology%2Fitem%2F796-procedures-for-the-collection-of-blood-for-hemotological-investigations&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Perry, Sally (2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/nursing.advanceweb.com\/Article\/Ask-the-Lab-Hemolyze-blood-specimens.aspx\" target=\"_blank\">\"Ask the Lab: Hemolyze blood specimens\"<\/a>. Nursing.advanceweb.com<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-12-29<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Ask+the+Lab%3A+Hemolyze+blood+specimens&rft.pub=Nursing.advanceweb.com&rft.date=2007&rft.aulast=Perry&rft.aufirst=Sally&rft_id=http%3A%2F%2Fnursing.advanceweb.com%2FArticle%2FAsk-the-Lab-Hemolyze-blood-specimens.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-rose-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-rose_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-rose_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rose, John B.; Galinkin, Jeffrey L.; Jantzen, Ellen C.; Chiavacci, Rosetta M. (2002). \"A Study of Lidocaine Iontophoresis for Pediatric Venipuncture\". <i>Anesthesia & Analgesia<\/i>. <b>94<\/b> (4): 867. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00000539-200204000-00017\" target=\"_blank\">10.1097\/00000539-200204000-00017<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesia+%26+Analgesia&rft.atitle=A+Study+of+Lidocaine+Iontophoresis+for+Pediatric+Venipuncture&rft.volume=94&rft.issue=4&rft.pages=867&rft.date=2002&rft_id=info%3Adoi%2F10.1097%2F00000539-200204000-00017&rft.aulast=Rose&rft.aufirst=John+B.&rft.au=Galinkin%2C+Jeffrey+L.&rft.au=Jantzen%2C+Ellen+C.&rft.au=Chiavacci%2C+Rosetta+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lacroix, Helene (2008-10-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ebn.bmj.com\/content\/11\/4\/106\" target=\"_blank\">\"A needle-free powder lignocaine delivery system reduced the pain of venipuncture in childrenCommentary\"<\/a>. <i>Evidence-Based Nursing<\/i>. <b>11<\/b> (4): 106\u2013106. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Febn.11.4.106\" target=\"_blank\">10.1136\/ebn.11.4.106<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1367-6539\" target=\"_blank\">1367-6539<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18815318\" target=\"_blank\">18815318<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Evidence-Based+Nursing&rft.atitle=A+needle-free+powder+lignocaine+delivery+system+reduced+the+pain+of+venipuncture+in+childrenCommentary&rft.volume=11&rft.issue=4&rft.pages=106-106&rft.date=2008-10-01&rft.issn=1367-6539&rft_id=info%3Apmid%2F18815318&rft_id=info%3Adoi%2F10.1136%2Febn.11.4.106&rft.aulast=Lacroix&rft.aufirst=Helene&rft_id=http%3A%2F%2Febn.bmj.com%2Fcontent%2F11%2F4%2F106&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ltd, BMJ Publishing Group Ltd and RCN Publishing Company (2006-01-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ebn.bmj.com\/content\/9\/1\/10\" target=\"_blank\">\"Liposomal lidocaine improved intravenous cannulation success rates in children\"<\/a>. <i>Evidence-Based Nursing<\/i>. <b>9<\/b> (1): 10\u201310. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Febn.9.1.10\" target=\"_blank\">10.1136\/ebn.9.1.10<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1367-6539\" target=\"_blank\">1367-6539<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16437788\" target=\"_blank\">16437788<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Evidence-Based+Nursing&rft.atitle=Liposomal+lidocaine+improved+intravenous+cannulation+success+rates+in+children&rft.volume=9&rft.issue=1&rft.pages=10-10&rft.date=2006-01-01&rft.issn=1367-6539&rft_id=info%3Apmid%2F16437788&rft_id=info%3Adoi%2F10.1136%2Febn.9.1.10&rft.aulast=Ltd&rft.aufirst=BMJ+Publishing+Group+Ltd+and+RCN+Publishing+Company&rft_id=http%3A%2F%2Febn.bmj.com%2Fcontent%2F9%2F1%2F10&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ltd, BMJ Publishing Group Ltd and RCN Publishing Company (2007-07-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ebn.bmj.com\/content\/10\/3\/75\" target=\"_blank\">\"Review: distraction, hypnosis, and combined cognitive-behavioural interventions reduce needle related pain and distress in children and adolescents\"<\/a>. <i>Evidence-Based Nursing<\/i>. <b>10<\/b> (3): 75\u201375. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Febn.10.3.75\" target=\"_blank\">10.1136\/ebn.10.3.75<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1367-6539\" target=\"_blank\">1367-6539<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17596380\" target=\"_blank\">17596380<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Evidence-Based+Nursing&rft.atitle=Review%3A+distraction%2C+hypnosis%2C+and+combined+cognitive-behavioural+interventions+reduce+needle+related+pain+and+distress+in+children+and+adolescents&rft.volume=10&rft.issue=3&rft.pages=75-75&rft.date=2007-07-01&rft.issn=1367-6539&rft_id=info%3Apmid%2F17596380&rft_id=info%3Adoi%2F10.1136%2Febn.10.3.75&rft.aulast=Ltd&rft.aufirst=BMJ+Publishing+Group+Ltd+and+RCN+Publishing+Company&rft_id=http%3A%2F%2Febn.bmj.com%2Fcontent%2F10%2F3%2F75&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hoff, J. (2000). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.lawte.org\/materials\/hoff.pdf\" target=\"_blank\">\"Methods of Blood Collection in the Mouse\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Lab Animal<\/i>. <b>29<\/b> (10): 47\u201353.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Lab+Animal&rft.atitle=Methods+of+Blood+Collection+in+the+Mouse&rft.volume=29&rft.issue=10&rft.pages=47-53&rft.date=2000&rft.aulast=Hoff&rft.aufirst=J.&rft_id=http%3A%2F%2Fwww.lawte.org%2Fmaterials%2Fhoff.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Parasuraman2010-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Parasuraman2010_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Parasuraman2010_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Parasuraman, S; Raveendran, R; Kesavan, R (2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3043327\" target=\"_blank\">\"Blood sample collection in small laboratory animals\"<\/a>. <i>Journal of Pharmacology and Pharmacotherapeutics<\/i>. <b>1<\/b> (2): 87\u201393. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4103%2F0976-500X.72350\" target=\"_blank\">10.4103\/0976-500X.72350<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3043327\" target=\"_blank\">3043327<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21350616\" target=\"_blank\">21350616<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Pharmacology+and+Pharmacotherapeutics&rft.atitle=Blood+sample+collection+in+small+laboratory+animals&rft.volume=1&rft.issue=2&rft.pages=87-93&rft.date=2010&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3043327&rft_id=info%3Apmid%2F21350616&rft_id=info%3Adoi%2F10.4103%2F0976-500X.72350&rft.aulast=Parasuraman&rft.aufirst=S&rft.au=Raveendran%2C+R&rft.au=Kesavan%2C+R&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3043327&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Parasuraman S, Zhen KM, Raveendran R. Retro-orbital Blood Sample Collection in Rats-a Video Article. PTB Reports 1 (2), 37-40|DOI : 10.5530\/PTB.1.2.1|Available in <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.ptbreports.org\/article\/41\" target=\"_blank\">http:\/\/www.ptbreports.org\/article\/41<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www-medlib.med.utah.edu\/WebPath\/TUTORIAL\/PHLEB\/PHLEB.html\" target=\"_blank\">Phlebotomy details<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1265\nCached time: 20181129155029\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.272 seconds\nReal time usage: 0.357 seconds\nPreprocessor visited node count: 834\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 45836\/2097152 bytes\nTemplate argument size: 180\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 27402\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.157\/10.000 seconds\nLua memory usage: 4.51 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 286.714 1 -total\n<\/p>\n<pre>60.89% 174.567 1 Template:Reflist\n42.61% 122.180 7 Template:Cite_journal\n18.73% 53.699 1 Template:More_citations_needed\n12.69% 36.373 1 Template:Ambox\n11.57% 33.162 2 Template:Cite_web\n 6.99% 20.047 3 Template:Navbox\n 6.79% 19.467 1 Template:Vascular_procedures\n 4.60% 13.182 1 Template:Col_div\n 4.54% 13.030 1 Template:See\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:234819-1!canonical and timestamp 20181129155028 and revision id 865400288\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Venipuncture\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214707\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.153 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 145.349 1 - wikipedia:Venipuncture\n100.00% 145.349 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8571-0!*!*!*!*!*!* and timestamp 20181217214707 and revision id 24999\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Venipuncture\">https:\/\/www.limswiki.org\/index.php\/Venipuncture<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","db384186b2f2a397cbd511159e88f7ba_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9b\/Venipuncture_using_a_BD_Vacutainer.JPG\/340px-Venipuncture_using_a_BD_Vacutainer.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ee\/Vacutainer_blood_bottles.jpg\/440px-Vacutainer_blood_bottles.jpg"],"db384186b2f2a397cbd511159e88f7ba_timestamp":1545083227,"3014f54069aaa56a07a85b820a8b84f8_type":"article","3014f54069aaa56a07a85b820a8b84f8_title":"Medical stitching","3014f54069aaa56a07a85b820a8b84f8_url":"https:\/\/www.limswiki.org\/index.php\/Surgical_suture#Techniques","3014f54069aaa56a07a85b820a8b84f8_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgical suture\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor other uses, see Suture.\nSurgical sutureSurgical suture on needle holder. Packaging shown above.[edit on Wikidata]\nSurgical suture is a medical device used to hold body tissues together after an injury or surgery. Application generally involves using a needle with an attached length of thread. A number of different shapes, sizes, and thread materials have been developed over its millennia of history. Surgeons, physicians, dentists, podiatrists, eye doctors, registered nurses and other trained nursing personnel, medics, and clinical pharmacists typically engage in suturing. Surgical knots are used to secure the sutures.\n\nContents \n\n1 Needles \n2 Thread \n\n2.1 Materials \n2.2 Absorbability \n2.3 Sizes \n\n\n3 Techniques \n\n3.1 Placement \n3.2 Stitching interval and spacing \n3.3 Layers \n3.4 Removal \n3.5 Expansions \n\n\n4 Tissue adhesives \n5 History \n6 See also \n7 References \n8 External links \n\n\nNeedles \nEyed or reusable needles with holes (called eyes), which are supplied separate from their suture thread, are necessary for suture. The suture must be threaded on site, as is done when sewing in a recreational setting. The advantage of this is that any thread and needle combination is possible to suit the job at hand. Swaged, or atraumatic, needles with sutures comprise a pre-packed eyeless needle attached to a specific length of suture thread. The suture manufacturer swages the suture thread to the eyeless atraumatic needle at the factory. The chief advantage of this is that the doctor or the nurse does not have to spend time threading the suture on the needle, which may be difficult for very fine needles and sutures. Also, the suture end of a swaged needle is narrower than the needle body, eliminating drag from the thread attachment site. In eyed needles, the thread protrudes from the needle body on both sides, and at best causes drag. When passing through friable tissues, the eye needle and suture combination may thus traumatise tissues more than a swaged needle, hence the designation of the latter as \"atraumatic\".\nThere are several shapes of surgical needles. These include:\n\nStraight\n1\/4 circle\n3\/8 circle\n1\/2 circle. Subtypes of this needle shape include, from larger to smaller size, CT, CT-1, CT-2 and CT-3.[1]\n5\/8 circle\ncompound curve\nhalf curved (also known as ski)\nhalf curved at both ends of a straight segment (also known as canoe)\nThe ski and canoe needle design allows curved needles to be straight enough to be used in laparoscopic surgery, where instruments are inserted into the abdominal cavity through narrow cannulas.\nNeedles may also be classified by their point geometry; examples include:\n\ntaper (needle body is round and tapers smoothly to a point)\ncutting (needle body is triangular and has a sharpened cutting edge on the inside curve)\nreverse cutting (cutting edge on the outside)\ntrocar point or tapercut (needle body is round and tapered, but ends in a small triangular cutting point)\nblunt points for sewing friable tissues\nside cutting or spatula points (flat on top and bottom with a cutting edge along the front to one side) for eye surgery\nFinally, atraumatic needles may be permanently swaged to the suture or may be designed to come off the suture with a sharp straight tug. These \"pop-offs\" are commonly used for interrupted sutures, where each suture is only passed once and then tied.\n\n\n\t\t\n\t\t\t\n\t\t\t\nEyed surgical needles which form 3\/8th of a circle, in different sizes.\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nEyed surgical needles which are semicircular, in different sizes.\n\n\t\t\t\n\t\t\n\nSutures can withstand different amounts of force based on their size; this is quantified by the U.S.P. Needle Pull Specifications.\n\nThread \nMaterials \n Micrograph of a H&E stained tissue section showing a non-absorbable multi-filament surgical suture with a surrounding foreign-body giant cell reaction\nFurther information: Suture materials comparison chart\nSuture thread is made from numerous materials. The original sutures were made from biological materials, such as catgut suture and silk. These absorbed bodily fluids and could be foci of infection. Founder of gynecology J. Marion Sims invented the use of silver wire, which is anti-bacterial, for a suture. Most modern sutures are synthetic, including the absorbables polyglycolic acid, polylactic acid, Monocryl and polydioxanone as well as the non-absorbables nylon, polyester, PVDF and polypropylene.[2] The FDA first approved triclosan-coated sutures in 2002;[3] they have been shown to reduce the chances of wound infection.[4] Sutures come in very specific sizes and may be either absorbable (naturally biodegradable in the body) or non-absorbable. Sutures must be strong enough to hold tissue securely but flexible enough to be knotted. They must be hypoallergenic and avoid the \"wick effect\" that would allow fluids and thus infection to penetrate the body along the suture tract.\n\nAbsorbability \nAll sutures are classified as either absorbable or non-absorbable depending on whether the body will naturally degrade and absorb the suture material over time. Absorbable suture materials include the original catgut as well as the newer synthetics polyglycolic acid, polylactic acid, polydioxanone, and caprolactone. \nAbsorbable (or resorbable) medical devices such as sutures are made of polymers. The polymer materials are based on one or more of five cyclic monomers: glycolide, l-lactide, p-dioxanone, trimethylene carbonate and \u03b5-caprolactone.[5]\nThey are broken down by various processes including hydrolysis (polyglycolic acid) and proteolytic enzymatic degradation. Depending on the material, the process can be from ten days to eight weeks. They are used in patients who cannot return for suture removal, or in internal body tissues.[6] In both cases, they will hold the body tissues together long enough to allow healing, but will disintegrate so that they do not leave foreign material or require further procedures. Initially, there is a foreign body reaction to the material, which is transient. After complete resorption only connective tissue will remain.[7][8][9][10] Occasionally, absorbable sutures can cause inflammation and be rejected by the body rather than absorbed.\n\n Twelve nonabsorbable sutures in a person's lower back.\nNon-absorbable sutures are made of special silk or the synthetics polypropylene, polyester or nylon. Stainless steel wires are commonly used in orthopedic surgery and for sternal closure in cardiac surgery. These may or may not have coatings to enhance their performance characteristics. Non-absorbable sutures are used either on skin wound closure, where the sutures can be removed after a few weeks, or in stressful internal environments where absorbable sutures will not suffice. Examples include the heart (with its constant pressure and movement) or the bladder (with adverse chemical conditions). Non-absorbable sutures often cause less scarring because they provoke less immune response, and thus are used where cosmetic outcome is important. They may be removed after a certain time, or left permanently.\n\nSizes \nThe examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. You may improve this article, discuss the issue on the talk page, or create a new article, as appropriate. (December 2010) (Learn how and when to remove this template message)\nSuture sizes are defined by the United States Pharmacopeia (U.S.P.). Sutures were originally manufactured ranging in size from #1 to #6, with #1 being the smallest. A #4 suture would be roughly the diameter of a tennis racquet string. The manufacturing techniques, derived at the beginning from the production of musical strings, did not allow thinner diameters. As the procedures improved, #0 was added to the suture diameters, and later, thinner and thinner threads were manufactured, which were identified as #00 (#2-0 or #2\/0) to #000000 (#6-0 or #6\/0).\nModern sutures range from #5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics). Atraumatic needles are manufactured in all shapes for most sizes. The actual diameter of thread for a given U.S.P. size differs depending on the suture material class.\n\n\n\nUSP\r\ndesignation\nCollagen\r\ndiameter (mm)\nSynthetic absorbable\r\ndiameter (mm)\nNon-absorbable\r\ndiameter (mm)\nAmerican \r\nwire gauge\n\n\n11-0\n\n\n0.01\n\n\n\n10-0\n0.02\n0.02\n0.02\n\n\n\n9-0\n0.03\n0.03\n0.03\n\n\n\n8-0\n0.05\n0.04\n0.04\n\n\n\n7-0\n0.07\n0.05\n0.05\n\n\n\n6-0\n0.1\n0.07\n0.07\n38\u201340\n\n\n5-0\n0.15\n0.1\n0.1\n35\u201338\n\n\n4-0\n0.2\n0.15\n0.15\n32\u201334\n\n\n3-0\n0.3\n0.2\n0.2\n29\u201332\n\n\n2-0\n0.35\n0.3\n0.3\n28\n\n\n0\n0.4\n0.35\n0.35\n26\u201327\n\n\n1\n0.5\n0.4\n0.4\n25\u201326\n\n\n2\n0.6\n0.5\n0.5\n23\u201324\n\n\n3\n0.7\n0.6\n0.6\n22\n\n\n4\n0.8\n0.6\n0.6\n21\u201322\n\n\n5\n\n0.7\n0.7\n20\u201321\n\n\n6\n\n\n0.8\n19\u201320\n\n\n7\n\n\n\n18\n\n\nTechniques \nSee also: Surgical knot\n A wound before and after suture closure. The closure incorporates five simple interrupted sutures and one vertical mattress suture (center) at the apex of the wound.\n Suturing two operation wounds with eleven simple stitches by a Cuban doctor. Sara, Guinea-Bissau, 1974.\nMany different techniques exist. The most common is the simple interrupted stitch;[11] it is indeed the simplest to perform and is called \"interrupted\" because the suture thread is cut between each individual stitch. The vertical and horizontal mattress stitch are also interrupted but are more complex and specialized for everting the skin and distributing tension. The running or continuous stitch is quicker but risks failing if the suture is cut in just one place; the continuous locking stitch is in some ways a more secure version. The chest drain stitch and corner stitch are variations of the horizontal mattress.\nOther stitches or suturing techniques include:\n\nPurse-string suture, a continuous, circular inverting suture which is made to secure apposition of the edges of a surgical or traumatic wound.[12][13]\nFigure 8 stitch\nSubcuticular stitch.\nPlacement \nSutures are placed by mounting a needle with attached suture into a needle holder. The needle point is pressed into the flesh, advanced along the trajectory of the needle's curve until it emerges, and pulled through. The trailing thread is then tied into a knot, usually a square knot or surgeon's knot. Ideally, sutures bring together the wound edges, without causing indenting or blanching of the skin,[14] since the blood supply may be impeded and thus increase infection and scarring.[15][16] Ideally, sutured skin rolls slightly outward from the wound (eversion), and the depth and width of the sutured flesh is roughly equal.[15] Placement varies based on the location,\n\nStitching interval and spacing \nSkin and other soft tissue can lengthen significantly under strain. To accommodate this lengthening, continuous stitches must have an adequate amount of slack. Jenkin's rule was the first research result in this area, showing that the then-typical use of a suture-length to wound-length ratio of 2:1 increased the risk of a burst wound, and suggesting a SL:WL ratio of 4:1 or more in abdominal wounds.[16][17] A later study suggested 6:1 as the optimal ratio in abdominal closure.[18]\n\nLayers \nIn contrast to single layer suturing, two layer suturing generally involves suturing at a deeper level of a tissue followed by another layer of suturing at a more superficial level. For example, Cesarean section can be performed with single or double layer suturing of the uterine incision.[19]\n\nRemoval \nWhereas some sutures are intended to be permanent, and others in specialized cases may be kept in place for an extended period of many weeks, as a rule sutures are a short term device to allow healing of a trauma or wound.\n\nDifferent parts of the body heal at different speeds. Common time to remove stitches will vary: facial wounds 3\u20135 days; scalp wound 7\u201310 days; limbs 10\u201314 days; joints 14 days; trunk of the body 7\u201310 days.[20]\n\nRemoval of sutures is traditionally achieved by using forceps to hold the suture thread steady and pointed scalpel blades or scissors to cut. For practical reasons the two instruments (forceps and scissors) are available in a sterile kit. In certain countries (e.g. US), these kits are available in sterile disposable trays because of the high cost of cleaning and re-sterilization.\n\nExpansions \nA pledgeted suture is one that is supported by a pledget, that is, a small flat non-absorbent pad normally composed of polytetrafluoroethylene, used as buttresses under sutures when there is a possibility of sutures tearing through tissue.[21]\n\nTissue adhesives \nTopical cyanoacrylate adhesives (industrially used as super glue), have been used in combination with, or as an alternative to, sutures in wound closure. The adhesive remains liquid until exposed to water or water-containing substances\/tissue, after which it cures (polymerizes) and forms a bond to the underlying surface. The tissue adhesive has been shown to act as a barrier to microbial penetration as long as the adhesive film remains intact. Limitations of tissue adhesives include contraindications to use near the eyes and a mild learning curve on correct usage. They are also unsuitable for oozing or potentially contaminated wounds.\nIn surgical incisions it does not work as well as sutures as the wounds often break open.[22]\nCyanoacrylate is the generic name for cyanoacrylate based fast-acting glues such as methyl-2-cyanoacrylate, ethyl-2-cyanoacrylate (commonly sold under trade names like Superglue and Krazy Glue) and n-butyl-cyanoacrylate. Skin glues like Indermil and Histoacryl were the first medical grade tissue adhesives to be used, and these are composed of n-butyl cyanoacrylate. These worked well but had the disadvantage of having to be stored in the refrigerator, were exothermic so they stung the patient, and the bond was brittle. Nowadays, the longer chain polymer, 2-octyl cyanoacrylate, is the preferred medical grade glue. It is available under various trade names, such as LiquiBand, SurgiSeal, FloraSeal, and Dermabond. These have the advantages of being more flexible, making a stronger bond, and being easier to use. The longer side chain types, for example octyl and butyl forms, also reduce tissue reaction.\n\nHistory \n Sewing wound after herniotomy, 1559\n Old refillable surgical thread supplier (middle of 20th century)\nThrough many millennia, various suture materials were used, debated, and remained largely unchanged. Needles were made of bone or metals such as silver, copper, and aluminium bronze wire. Sutures were made of plant materials (flax, hemp and cotton) or animal material (hair, tendons, arteries, muscle strips and nerves, silk, and catgut).\nThe earliest reports of surgical suture date to 3000 BC in ancient Egypt, and the oldest known suture is in a mummy from 1100 BC. A detailed description of a wound suture and the suture materials used in it is by the Indian sage and physician Sushruta, written in 500 BC.[23] The Greek father of medicine, Hippocrates, described suture techniques, as did the later Roman Aulus Cornelius Celsus. The 2nd-century Roman physician Galen described gut sutures.[24] In the 10th century, the catgut suture along with the surgery needle were developed by Abulcasis[25][26]. The catgut suture was similar to that of strings for violins, guitar, and tennis racquet and it involved harvesting sheep intestines.\nJoseph Lister endorsed the routine sterilization of all suture threads. He first attempted sterilization with the 1860s \"carbolic catgut,\" and chromic catgut followed two decades later. Sterile catgut was finally achieved in 1906 with iodine treatment.\nThe next great leap came in the twentieth century. The chemical industry drove production of the first synthetic thread in the early 1930s, which exploded into production of numerous absorbable and non-absorbable synthetics. The first synthetic absorbable was based on polyvinyl alcohol in 1931. Polyesters were developed in the 1950s, and later the process of radiation sterilization was established for catgut and polyester. Polyglycolic acid was discovered in the 1960s and implemented in the 1970s. Today, most sutures are made of synthetic polymer fibers. Silk and, rarely, gut sutures are the only materials still in use from ancient times. In fact, gut sutures have been banned in Europe and Japan owing to concerns regarding Bovine Spongiform Encephalopathy. Silk suture is still used, mainly to secure surgical drains.\n\nSee also \n\nAlexis Carrel\nBarbed suture\nButterfly closure\nCheesewiring\nChitin\nCyanoacrylate\nKnots\nLigature\nList of medical topics\nSewing\nSurgical staple\nWound closure strips\n\nReferences \n\n\n^ Surgical Needle Guide from Novartis. Copyright 2005. \n\n^ \"Types of Sutures\". Dolphin Sutures. Retrieved 2014-01-07 . \n\n^ ETHICON Products (20 December 2002). \"ETHICON Receives FDA Clearance to Market VICRYL* Plus, First Ever Antibacterial Suture\". PRNewswire. Retrieved 25 January 2016 . \n\n^ Daoud, FC; Edmiston CE, Jr; Leaper, D (June 2014). \"Meta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: robustness to new evidence\". Surgical infections. 15 (3): 165\u201381. doi:10.1089\/sur.2013.177. PMC 4063374 . PMID 24738988. \n\n^ H\u00f6glund, Odd Viking (2012). A resorbable device for ligation of blood vessels : development, assessment of surgical procedures and clinical evaluation (PDF) . pp. 17\u201319. ISBN 978-91-576-7686-3. \n\n^ \"Suture Materials - Classification - Surgical Needles - TeachMeSurgery\". \n\n^ H\u00f6glund, Odd Viking (2012). A resorbable device for ligation of blood vessels : development, assessment of surgical procedures and clinical evaluation (PDF) . ISBN 978-91-576-7686-3. \n\n^ H\u00f6glund, Odd V; Ingman, Jessica; S\u00f6dersten, Fredrik; Hansson, Kerstin; Borg, Niklas; Lagerstedt, Anne-Sofie (2014). \"Ligation of the spermatic cord in dogs with a self-locking device of a resorbable polyglycolic based co-polymer \u2013 feasibility and long-term follow-up study\". BMC Research Notes. 7 (1): 825. doi:10.1186\/1756-0500-7-825. \n\n^ Hjort, H.; Mathisen, T.; Alves, A.; Clermont, G.; Boutrand, J. P. (5 October 2011). \"Three-year results from a preclinical implantation study of a long-term resorbable surgical mesh with time-dependent mechanical characteristics\". Hernia. 16 (2): 191\u2013197. doi:10.1007\/s10029-011-0885-y. \n\n^ Anderson, James M.; Rodriguez, Analiz; Chang, David T. (April 2008). \"Foreign body reaction to biomaterials\". Seminars in Immunology. 20 (2): 86\u2013100. doi:10.1016\/j.smim.2007.11.004. PMC 2327202 . \n\n^ Lammers, Richard L; Trott, Alexander T (2004). \"Chapter 36: Methods of Wound Closure\". In Roberts, James R; Hedges, Jerris R. Clinical Procedures in Emergency Medicine (4th ed.). Philadelphia: Saunders. p. 671. ISBN 0-7216-9760-7. \n\n^ Dorland's Medical Dictionary for Health Consumers. Copyright 2007 \n\n^ Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. \n\n^ Osterberg, B; Blomstedt, B (1979). \"Effect of suture materials on bacterial survival in infected wounds: An experimental study\". Acta Chir Scand. 145: 431. \n\n^ a b Macht, SD; Krizek, TJ (1978). \"Sutures and suturing - Current concepts\". Journal of Oral Surgery. 36: 710. \n\n^ a b Kirk, RM (1978). Basic Surgical Techniques. Edinburgh: Churchill Livingstone. \n\n^ Grossman, JA (1982). \"The repair of surface trauma\". Emergency Medicine. 14: 220. \n\n^ Varshney, S; Manek, P; Johnson, CD (September 1999). \"Six-fold suture:wound length ratio for abdominal closure\". Annals of the Royal College of Surgeons of England. 81 (5): 333\u20136. PMC 2503300 . PMID 10645176. \n\n^ Stark, M.; Chavkin, Y.; Kupfersztain, C.; Guedj, P.; Finkel, A. R. (1995). \"Evaluation of combinations of procedures in cesarean section\". International Journal of Gynecology & Obstetrics. 48 (3): 273\u20136. doi:10.1016\/0020-7292(94)02306-J. PMID 7781869. \n\n^ \"www.scribd.com\". \n\n^ \"Polytetrafluoroethylene Pledget\". \n\n^ Dumville, JC; Coulthard, P; Worthington, HV; Riley, P; Patel, N; Darcey, J; Esposito, M; van der Elst, M; van Waes, OJ (28 November 2014). \"Tissue adhesives for closure of surgical incisions\". The Cochrane Database of Systematic Reviews. 11: CD004287. doi:10.1002\/14651858.CD004287.pub4. PMID 25431843. \n\n^ Mysore, Venkataram. Acs(I) Textbook on Cutaneous and Aesthetic Surgery. Jaypee Brothers Medical Publishers Pvt. Ltd. pp. 125\u2013126. ISBN 9789350905913. Retrieved 25 January 2016 . \n\n^ Nutton, Dr Vivia (2005-07-30). Ancient Medicine. Taylor & Francis US. ISBN 9780415368483. Retrieved 21 November 2012 . \n\n^ Rooney, Anne (2009). The Story of Medicine. Arcturus Publishing. ISBN 9781848580398. \n\n^ Rakel, David; Rakel, Robert E. (2011). Textbook of Family Medicine E-Book. Elsevier Health Sciences. ISBN 1437735673. \n\n\nExternal links \n Media related to Surgical suture at Wikimedia Commons\n\nComputer modelling of sutures\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_suture#Techniques\">https:\/\/www.limswiki.org\/index.php\/Surgical_suture#Techniques<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 March 2016, at 20:14.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 435 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","3014f54069aaa56a07a85b820a8b84f8_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Surgical_suture skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surgical suture<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Suture_(disambiguation)\" class=\"mw-redirect mw-disambig\" title=\"Suture (disambiguation)\" rel=\"external_link\" target=\"_blank\">Suture<\/a>.<\/div>\n\n<p><b>Surgical suture<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> used to hold <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_(biology)\" title=\"Tissue (biology)\" rel=\"external_link\" target=\"_blank\">body tissues<\/a> together after an injury or surgery. Application generally involves using a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sewing_needle\" title=\"Sewing needle\" rel=\"external_link\" target=\"_blank\">needle<\/a> with an attached length of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thread_(yarn)\" title=\"Thread (yarn)\" rel=\"external_link\" target=\"_blank\">thread<\/a>. A number of different shapes, sizes, and thread materials have been developed over its millennia of history. Surgeons, physicians, dentists, podiatrists, eye doctors, registered nurses and other trained nursing personnel, medics, and clinical pharmacists typically engage in suturing. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_knot\" title=\"Surgical knot\" rel=\"external_link\" target=\"_blank\">Surgical knots<\/a> are used to secure the sutures.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Needles\">Needles<\/span><\/h2>\n<p>Eyed or reusable needles with holes (called eyes), which are supplied separate from their suture thread, are necessary for suture. The suture must be threaded on site, as is done when sewing in a recreational setting. The advantage of this is that any thread and needle combination is possible to suit the job at hand. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Swage\" class=\"mw-redirect\" title=\"Swage\" rel=\"external_link\" target=\"_blank\">Swaged<\/a>, or atraumatic, needles with sutures comprise a pre-packed eyeless needle attached to a specific length of suture thread. The suture manufacturer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Swage\" class=\"mw-redirect\" title=\"Swage\" rel=\"external_link\" target=\"_blank\">swages<\/a> the suture thread to the eyeless atraumatic needle at the factory. The chief advantage of this is that the doctor or the nurse does not have to spend time threading the suture on the needle, which may be difficult for very fine needles and sutures. Also, the suture end of a swaged needle is narrower than the needle body, eliminating drag from the thread attachment site. In eyed needles, the thread protrudes from the needle body on both sides, and at best causes drag. When passing through friable tissues, the eye needle and suture combination may thus traumatise tissues more than a swaged needle, hence the designation of the latter as \"atraumatic\".\n<\/p><p>There are several shapes of surgical needles. These include:\n<\/p>\n<ul><li>Straight<\/li>\n<li>1\/4 circle<\/li>\n<li>3\/8 circle<\/li>\n<li>1\/2 circle. Subtypes of this needle shape include, from larger to smaller size, CT, CT-1, CT-2 and CT-3.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><\/li>\n<li>5\/8 circle<\/li>\n<li>compound curve<\/li>\n<li>half curved (also known as ski)<\/li>\n<li>half curved at both ends of a straight segment (also known as canoe)<\/li><\/ul>\n<p>The ski and canoe needle design allows curved needles to be straight enough to be used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic_surgery\" class=\"mw-redirect\" title=\"Laparoscopic surgery\" rel=\"external_link\" target=\"_blank\">laparoscopic surgery<\/a>, where instruments are inserted into the abdominal cavity through narrow cannulas.\n<\/p><p>Needles may also be classified by their point geometry; examples include:\n<\/p>\n<ul><li>taper (needle body is round and tapers smoothly to a point)<\/li>\n<li>cutting (needle body is triangular and has a sharpened cutting edge on the inside curve)<\/li>\n<li>reverse cutting (cutting edge on the outside)<\/li>\n<li>trocar point or tapercut (needle body is round and tapered, but ends in a small triangular cutting point)<\/li>\n<li>blunt points for sewing friable tissues<\/li>\n<li>side cutting or spatula points (flat on top and bottom with a cutting edge along the front to one side) for eye surgery<\/li><\/ul>\n<p>Finally, atraumatic needles may be permanently swaged to the suture or may be designed to come off the suture with a sharp straight tug. These \"pop-offs\" are commonly used for interrupted sutures, where each suture is only passed once and then tied.\n<\/p>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:27.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HechtnaaldenB.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3a\/HechtnaaldenB.jpg\/120px-HechtnaaldenB.jpg\" width=\"120\" height=\"95\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Eyed surgical needles which form 3\/8th of a circle, in different sizes.\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:23.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HechtnaaldenG.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/HechtnaaldenG.jpg\/120px-HechtnaaldenG.jpg\" width=\"120\" height=\"103\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Eyed surgical needles which are semicircular, in different sizes.\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<p>Sutures can withstand different amounts of force based on their size; this is quantified by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S.P._Needle_Pull_Specifications\" title=\"U.S.P. Needle Pull Specifications\" rel=\"external_link\" target=\"_blank\">U.S.P. Needle Pull Specifications<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Thread\">Thread<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Materials\">Materials<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Suture_micrograph.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9e\/Suture_micrograph.jpg\/220px-Suture_micrograph.jpg\" width=\"220\" height=\"164\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Suture_micrograph.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Micrograph\" title=\"Micrograph\" rel=\"external_link\" target=\"_blank\">Micrograph<\/a> of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/H%26E_stain\" title=\"H&E stain\" rel=\"external_link\" target=\"_blank\">H&E stained<\/a> tissue section showing a non-absorbable multi-filament surgical suture with a surrounding <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign-body_giant_cell\" title=\"Foreign-body giant cell\" rel=\"external_link\" target=\"_blank\">foreign-body giant cell<\/a> reaction<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Suture_materials_comparison_chart\" title=\"Suture materials comparison chart\" rel=\"external_link\" target=\"_blank\">Suture materials comparison chart<\/a><\/div>\n<p>Suture thread is made from numerous materials. The original sutures were made from biological materials, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut_suture\" title=\"Catgut suture\" rel=\"external_link\" target=\"_blank\">catgut suture<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silk\" title=\"Silk\" rel=\"external_link\" target=\"_blank\">silk<\/a>. These absorbed bodily fluids and could be foci of infection. Founder of gynecology <a href=\"https:\/\/en.wikipedia.org\/wiki\/J._Marion_Sims\" title=\"J. Marion Sims\" rel=\"external_link\" target=\"_blank\">J. Marion Sims<\/a> invented the use of silver wire, which is anti-bacterial, for a suture. Most modern sutures are synthetic, including the absorbables <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolic_acid\" class=\"mw-redirect\" title=\"Polyglycolic acid\" rel=\"external_link\" target=\"_blank\">polyglycolic acid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polylactic_acid\" title=\"Polylactic acid\" rel=\"external_link\" target=\"_blank\">polylactic acid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Monocryl\" title=\"Monocryl\" rel=\"external_link\" target=\"_blank\">Monocryl<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polydioxanone\" title=\"Polydioxanone\" rel=\"external_link\" target=\"_blank\">polydioxanone<\/a> as well as the non-absorbables <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nylon\" title=\"Nylon\" rel=\"external_link\" target=\"_blank\">nylon<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">polyester<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyvinylidene_fluoride\" title=\"Polyvinylidene fluoride\" rel=\"external_link\" target=\"_blank\">PVDF<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polypropylene\" title=\"Polypropylene\" rel=\"external_link\" target=\"_blank\">polypropylene<\/a>.<sup id=\"rdp-ebb-cite_ref-SutureTypes_2-0\" class=\"reference\"><a href=\"#cite_note-SutureTypes-2\" rel=\"external_link\">[2]<\/a><\/sup> The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">FDA<\/a> first approved <a href=\"https:\/\/en.wikipedia.org\/wiki\/Triclosan\" title=\"Triclosan\" rel=\"external_link\" target=\"_blank\">triclosan<\/a>-coated sutures in 2002;<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> they have been shown to reduce the chances of wound infection.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Sutures come in very specific sizes and may be either absorbable (naturally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biodegradation\" title=\"Biodegradation\" rel=\"external_link\" target=\"_blank\">biodegradable<\/a> in the body) or non-absorbable. Sutures must be strong enough to hold tissue securely but flexible enough to be knotted. They must be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoallergenic\" title=\"Hypoallergenic\" rel=\"external_link\" target=\"_blank\">hypoallergenic<\/a> and avoid the \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Capillary_action\" title=\"Capillary action\" rel=\"external_link\" target=\"_blank\">wick<\/a> effect\" that would allow fluids and thus infection to penetrate the body along the suture tract.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Absorbability\">Absorbability<\/span><\/h3>\n<p>All sutures are classified as either absorbable or non-absorbable depending on whether the body will naturally degrade and absorb the suture material over time. <i>Absorbable<\/i> suture materials include the original <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut_suture\" title=\"Catgut suture\" rel=\"external_link\" target=\"_blank\">catgut<\/a> as well as the newer synthetics <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolic_acid\" class=\"mw-redirect\" title=\"Polyglycolic acid\" rel=\"external_link\" target=\"_blank\">polyglycolic acid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polylactic_acid\" title=\"Polylactic acid\" rel=\"external_link\" target=\"_blank\">polylactic acid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polydioxanone\" title=\"Polydioxanone\" rel=\"external_link\" target=\"_blank\">polydioxanone<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Caprolactone\" title=\"Caprolactone\" rel=\"external_link\" target=\"_blank\">caprolactone<\/a>. \nAbsorbable (or resorbable) medical devices such as sutures are made of polymers. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer_material\" class=\"mw-redirect\" title=\"Polymer material\" rel=\"external_link\" target=\"_blank\">polymer materials<\/a> are based on one or more of five cyclic monomers: glycolide, l-lactide, p-dioxanone, trimethylene carbonate and \u03b5-caprolactone.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>They are broken down by various processes including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrolysis\" title=\"Hydrolysis\" rel=\"external_link\" target=\"_blank\">hydrolysis<\/a> (polyglycolic acid) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proteolysis\" title=\"Proteolysis\" rel=\"external_link\" target=\"_blank\">proteolytic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Enzyme\" title=\"Enzyme\" rel=\"external_link\" target=\"_blank\">enzymatic<\/a> degradation. Depending on the material, the process can be from ten days to eight weeks. They are used in patients who cannot return for suture removal, or in internal body tissues.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> In both cases, they will hold the body tissues together long enough to allow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Healing\" title=\"Healing\" rel=\"external_link\" target=\"_blank\">healing<\/a>, but will disintegrate so that they do not leave foreign material or require further procedures. Initially, there is a foreign body reaction to the material, which is transient. After complete resorption only connective tissue will remain.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> Occasionally, absorbable sutures can cause inflammation and be rejected by the body rather than absorbed.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:12_Stitches.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4e\/12_Stitches.jpg\/220px-12_Stitches.jpg\" width=\"220\" height=\"295\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:12_Stitches.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Twelve nonabsorbable sutures in a person's lower back.<\/div><\/div><\/div>\n<p><i>Non-absorbable sutures<\/i> are made of special <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silk\" title=\"Silk\" rel=\"external_link\" target=\"_blank\">silk<\/a> or the synthetics <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polypropylene\" title=\"Polypropylene\" rel=\"external_link\" target=\"_blank\">polypropylene<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">polyester<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nylon\" title=\"Nylon\" rel=\"external_link\" target=\"_blank\">nylon<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">Stainless steel<\/a> wires are commonly used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic_surgery\" title=\"Orthopedic surgery\" rel=\"external_link\" target=\"_blank\">orthopedic surgery<\/a> and for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_sternum\" class=\"mw-redirect\" title=\"Human sternum\" rel=\"external_link\" target=\"_blank\">sternal<\/a> closure in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_surgery\" title=\"Cardiac surgery\" rel=\"external_link\" target=\"_blank\">cardiac surgery<\/a>. These may or may not have coatings to enhance their performance characteristics. Non-absorbable sutures are used either on skin wound closure, where the sutures can be removed after a few weeks, or in stressful internal environments where absorbable sutures will not suffice. Examples include the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart\" title=\"Heart\" rel=\"external_link\" target=\"_blank\">heart<\/a> (with its constant pressure and movement) or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bladder\" class=\"mw-redirect\" title=\"Bladder\" rel=\"external_link\" target=\"_blank\">bladder<\/a> (with adverse chemical conditions). Non-absorbable sutures often cause less <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scar\" title=\"Scar\" rel=\"external_link\" target=\"_blank\">scarring<\/a> because they provoke less <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immune_response\" title=\"Immune response\" rel=\"external_link\" target=\"_blank\">immune response<\/a>, and thus are used where cosmetic outcome is important. They may be removed after a certain time, or left permanently.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Sizes\">Sizes<\/span><\/h3>\n\n<p>Suture sizes are defined by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Pharmacopeia\" title=\"United States Pharmacopeia\" rel=\"external_link\" target=\"_blank\">United States Pharmacopeia<\/a> (U.S.P.). Sutures were originally manufactured ranging in size from #1 to #6, with #1 being the smallest. A #4 suture would be roughly the diameter of a tennis racquet string. The manufacturing techniques, derived at the beginning from the production of musical strings, did not allow thinner diameters. As the procedures improved, #0 was added to the suture diameters, and later, thinner and thinner threads were manufactured, which were identified as #00 (#2-0 or #2\/0) to #000000 (#6-0 or #6\/0).\n<\/p><p>Modern sutures range from #5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics). Atraumatic needles are manufactured in all shapes for most sizes. The actual diameter of thread for a given U.S.P. size differs depending on the suture material class.\n<\/p>\n<dl><dd><table class=\"wikitable\" style=\"\">\n<tbody><tr>\n<th>USP<br \/>designation<\/th>\n<th>Collagen<br \/>diameter (mm)<\/th>\n<th>Synthetic absorbable<br \/>diameter (mm)<\/th>\n<th>Non-absorbable<br \/>diameter (mm)<\/th>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_wire_gauge\" title=\"American wire gauge\" rel=\"external_link\" target=\"_blank\">American <br \/>wire gauge<\/a>\n<\/th><\/tr>\n<tr>\n<td>11-0<\/td>\n<td><\/td>\n<td><\/td>\n<td>0.01<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>10-0<\/td>\n<td>0.02<\/td>\n<td>0.02<\/td>\n<td>0.02<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>9-0<\/td>\n<td>0.03<\/td>\n<td>0.03<\/td>\n<td>0.03<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>8-0<\/td>\n<td>0.05<\/td>\n<td>0.04<\/td>\n<td>0.04<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>7-0<\/td>\n<td>0.07<\/td>\n<td>0.05<\/td>\n<td>0.05<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>6-0<\/td>\n<td>0.1<\/td>\n<td>0.07<\/td>\n<td>0.07<\/td>\n<td>38\u201340\n<\/td><\/tr>\n<tr>\n<td>5-0<\/td>\n<td>0.15<\/td>\n<td>0.1<\/td>\n<td>0.1<\/td>\n<td>35\u201338\n<\/td><\/tr>\n<tr>\n<td>4-0<\/td>\n<td>0.2<\/td>\n<td>0.15<\/td>\n<td>0.15<\/td>\n<td>32\u201334\n<\/td><\/tr>\n<tr>\n<td>3-0<\/td>\n<td>0.3<\/td>\n<td>0.2<\/td>\n<td>0.2<\/td>\n<td>29\u201332\n<\/td><\/tr>\n<tr>\n<td>2-0<\/td>\n<td>0.35<\/td>\n<td>0.3<\/td>\n<td>0.3<\/td>\n<td>28\n<\/td><\/tr>\n<tr>\n<td>0<\/td>\n<td>0.4<\/td>\n<td>0.35<\/td>\n<td>0.35<\/td>\n<td>26\u201327\n<\/td><\/tr>\n<tr>\n<td>1<\/td>\n<td>0.5<\/td>\n<td>0.4<\/td>\n<td>0.4<\/td>\n<td>25\u201326\n<\/td><\/tr>\n<tr>\n<td>2<\/td>\n<td>0.6<\/td>\n<td>0.5<\/td>\n<td>0.5<\/td>\n<td>23\u201324\n<\/td><\/tr>\n<tr>\n<td>3<\/td>\n<td>0.7<\/td>\n<td>0.6<\/td>\n<td>0.6<\/td>\n<td>22\n<\/td><\/tr>\n<tr>\n<td>4<\/td>\n<td>0.8<\/td>\n<td>0.6<\/td>\n<td>0.6<\/td>\n<td>21\u201322\n<\/td><\/tr>\n<tr>\n<td>5<\/td>\n<td><\/td>\n<td>0.7<\/td>\n<td>0.7<\/td>\n<td>20\u201321\n<\/td><\/tr>\n<tr>\n<td>6<\/td>\n<td><\/td>\n<td><\/td>\n<td>0.8<\/td>\n<td>19\u201320\n<\/td><\/tr>\n<tr>\n<td>7<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td>18\n<\/td><\/tr>\n<\/tbody><\/table><\/dd><\/dl>\n<h2><span class=\"mw-headline\" id=\"Techniques\">Techniques<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_knot\" title=\"Surgical knot\" rel=\"external_link\" target=\"_blank\">Surgical knot<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Suture,_before_and_after,_RMO.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/07\/Suture%2C_before_and_after%2C_RMO.jpg\/220px-Suture%2C_before_and_after%2C_RMO.jpg\" width=\"220\" height=\"330\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Suture,_before_and_after,_RMO.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A wound before and after suture closure. The closure incorporates five <a href=\"https:\/\/en.wikipedia.org\/wiki\/Simple_interrupted_stitch\" title=\"Simple interrupted stitch\" rel=\"external_link\" target=\"_blank\">simple interrupted sutures<\/a> and one <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertical_mattress_stitch\" title=\"Vertical mattress stitch\" rel=\"external_link\" target=\"_blank\">vertical mattress suture<\/a> (center) at the apex of the wound.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara,_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/70\/ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara%2C_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif\/lossy-page1-220px-ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara%2C_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara,_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Suturing two operation wounds with eleven simple stitches by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cuban_medical_internationalism\" title=\"Cuban medical internationalism\" rel=\"external_link\" target=\"_blank\">Cuban doctor<\/a>. Sara, Guinea-Bissau, 1974.<\/div><\/div><\/div>\n<p>Many different techniques exist. The most common is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Simple_interrupted_stitch\" title=\"Simple interrupted stitch\" rel=\"external_link\" target=\"_blank\">simple interrupted stitch<\/a>;<sup id=\"rdp-ebb-cite_ref-rh_11-0\" class=\"reference\"><a href=\"#cite_note-rh-11\" rel=\"external_link\">[11]<\/a><\/sup> it is indeed the simplest to perform and is called \"interrupted\" because the suture thread is cut between each individual stitch. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertical_mattress_stitch\" title=\"Vertical mattress stitch\" rel=\"external_link\" target=\"_blank\">vertical<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Horizontal_mattress_stitch\" title=\"Horizontal mattress stitch\" rel=\"external_link\" target=\"_blank\">horizontal mattress stitch<\/a> are also interrupted but are more complex and specialized for everting the skin and distributing tension. The running or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Running_stitch\" title=\"Running stitch\" rel=\"external_link\" target=\"_blank\">continuous stitch<\/a> is quicker but risks failing if the suture is cut in just one place; the continuous locking stitch is in some ways a more secure version. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chest_drain_stitch\" class=\"mw-redirect\" title=\"Chest drain stitch\" rel=\"external_link\" target=\"_blank\">chest drain stitch<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corner_stitch\" title=\"Corner stitch\" rel=\"external_link\" target=\"_blank\">corner stitch<\/a> are variations of the horizontal mattress.\n<\/p><p>Other stitches or suturing techniques include:\n<\/p>\n<ul><li><i>Purse-string suture<\/i>, a continuous, circular inverting suture which is made to secure apposition of the edges of a surgical or traumatic wound.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><\/li>\n<li>Figure 8 stitch<\/li>\n<li>Subcuticular stitch.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Placement\">Placement<\/span><\/h3>\n<p>Sutures are placed by mounting a needle with attached suture into a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Needle_holder\" title=\"Needle holder\" rel=\"external_link\" target=\"_blank\">needle holder<\/a>. The needle point is pressed into the flesh, advanced along the trajectory of the needle's curve until it emerges, and pulled through. The trailing thread is then tied into a knot, usually a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reef_knot\" title=\"Reef knot\" rel=\"external_link\" target=\"_blank\">square knot<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgeon%27s_knot\" title=\"Surgeon's knot\" rel=\"external_link\" target=\"_blank\">surgeon's knot<\/a>. Ideally, sutures bring together the wound edges, without causing indenting or blanching of the skin,<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> since the blood supply may be impeded and thus increase <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a> and scarring.<sup id=\"rdp-ebb-cite_ref-macht_15-0\" class=\"reference\"><a href=\"#cite_note-macht-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-kirk_16-0\" class=\"reference\"><a href=\"#cite_note-kirk-16\" rel=\"external_link\">[16]<\/a><\/sup> Ideally, sutured skin rolls slightly outward from the wound (eversion), and the depth and width of the sutured flesh is roughly equal.<sup id=\"rdp-ebb-cite_ref-macht_15-1\" class=\"reference\"><a href=\"#cite_note-macht-15\" rel=\"external_link\">[15]<\/a><\/sup> Placement varies based on the location,\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Stitching_interval_and_spacing\">Stitching interval and spacing<\/span><\/h3>\n<p>Skin and other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soft_tissue\" title=\"Soft tissue\" rel=\"external_link\" target=\"_blank\">soft tissue<\/a> can lengthen significantly under strain. To accommodate this lengthening, continuous stitches must have an adequate amount of slack. <b>Jenkin's rule<\/b> was the first research result in this area, showing that the then-typical use of a suture-length to wound-length ratio of 2:1 increased the risk of a burst wound, and suggesting a SL:WL ratio of 4:1 or more in abdominal wounds.<sup id=\"rdp-ebb-cite_ref-kirk_16-1\" class=\"reference\"><a href=\"#cite_note-kirk-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> A later study suggested 6:1 as the optimal ratio in abdominal closure.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Layers\">Layers<\/span><\/h3>\n<p>In contrast to <i>single layer suturing<\/i>, <i>two layer suturing<\/i> generally involves suturing at a deeper level of a tissue followed by another layer of suturing at a more superficial level. For example, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cesarean_section\" class=\"mw-redirect\" title=\"Cesarean section\" rel=\"external_link\" target=\"_blank\">Cesarean section<\/a> can be performed with single or double layer suturing of the uterine incision.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Removal\">Removal<\/span><\/h3>\n<p>Whereas some sutures are intended to be permanent, and others in specialized cases may be kept in place for an extended period of many weeks, as a rule sutures are a short term device to allow healing of a trauma or wound.\n<\/p>\n<blockquote class=\"templatequote\"><p>Different parts of the body heal at different speeds. Common time to remove stitches will vary: facial wounds 3\u20135 days; scalp wound 7\u201310 days; limbs 10\u201314 days; joints 14 days; trunk of the body 7\u201310 days.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><\/blockquote>\n<p>Removal of sutures is traditionally achieved by using forceps to hold the suture thread steady and pointed scalpel blades or scissors to cut. For practical reasons the two instruments (forceps and scissors) are available in a sterile kit. In certain countries (e.g. US), these kits are available in sterile disposable trays because of the high cost of cleaning and re-sterilization.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Expansions\">Expansions<\/span><\/h3>\n<p>A <i>pledgeted suture<\/i> is one that is supported by a <i>pledget<\/i>, that is, a small flat non-absorbent pad normally composed of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polytetrafluoroethylene\" title=\"Polytetrafluoroethylene\" rel=\"external_link\" target=\"_blank\">polytetrafluoroethylene<\/a>, used as buttresses under sutures when there is a possibility of sutures tearing through tissue.<sup id=\"rdp-ebb-cite_ref-bard_21-0\" class=\"reference\"><a href=\"#cite_note-bard-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Tissue_adhesives\">Tissue adhesives<\/span><\/h2>\n<p>Topical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyanoacrylate\" title=\"Cyanoacrylate\" rel=\"external_link\" target=\"_blank\">cyanoacrylate<\/a> adhesives (industrially used as super glue), have been used in combination with, or as an alternative to, sutures in wound closure. The adhesive remains liquid until exposed to water or water-containing substances\/tissue, after which it cures (polymerizes) and forms a bond to the underlying surface. The tissue adhesive has been shown to act as a barrier to microbial penetration as long as the adhesive film remains intact. Limitations of tissue adhesives include contraindications to use near the eyes and a mild learning curve on correct usage. They are also unsuitable for oozing or potentially contaminated wounds.\n<\/p><p>In surgical incisions it does not work as well as sutures as the wounds often break open.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p><p>Cyanoacrylate is the generic name for cyanoacrylate based fast-acting glues such as methyl-2-cyanoacrylate, ethyl-2-cyanoacrylate (commonly sold under trade names like Superglue and Krazy Glue) and n-butyl-cyanoacrylate. Skin glues like Indermil and Histoacryl were the first medical grade tissue adhesives to be used, and these are composed of n-butyl cyanoacrylate. These worked well but had the disadvantage of having to be stored in the refrigerator, were exothermic so they stung the patient, and the bond was brittle. Nowadays, the longer chain polymer, 2-octyl cyanoacrylate, is the preferred medical grade glue. It is available under various trade names, such as LiquiBand, SurgiSeal, FloraSeal, and Dermabond. These have the advantages of being more flexible, making a stronger bond, and being easier to use. The longer side chain types, for example octyl and butyl forms, also reduce tissue reaction.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:C._Stromayr;_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/57\/C._Stromayr%3B_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg\/220px-C._Stromayr%3B_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg\" width=\"220\" height=\"246\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:C._Stromayr;_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Sewing wound after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Herniotomy\" class=\"mw-redirect\" title=\"Herniotomy\" rel=\"external_link\" target=\"_blank\">herniotomy<\/a>, 1559<\/div><\/div><\/div>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_thread_supplier_1.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bf\/Surgical_thread_supplier_1.jpg\/170px-Surgical_thread_supplier_1.jpg\" width=\"170\" height=\"255\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_thread_supplier_1.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Old refillable surgical thread supplier (middle of 20th century)<\/div><\/div><\/div>\n<p>Through many millennia, various suture materials were used, debated, and remained largely unchanged. Needles were made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> or metals such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silver\" title=\"Silver\" rel=\"external_link\" target=\"_blank\">silver<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copper\" title=\"Copper\" rel=\"external_link\" target=\"_blank\">copper<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aluminium\" title=\"Aluminium\" rel=\"external_link\" target=\"_blank\">aluminium<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bronze\" title=\"Bronze\" rel=\"external_link\" target=\"_blank\">bronze<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wire\" title=\"Wire\" rel=\"external_link\" target=\"_blank\">wire<\/a>. Sutures were made of plant materials (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Flax\" title=\"Flax\" rel=\"external_link\" target=\"_blank\">flax<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemp\" title=\"Hemp\" rel=\"external_link\" target=\"_blank\">hemp<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cotton\" title=\"Cotton\" rel=\"external_link\" target=\"_blank\">cotton<\/a>) or animal material (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Hair\" title=\"Hair\" rel=\"external_link\" target=\"_blank\">hair<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tendons\" class=\"mw-redirect\" title=\"Tendons\" rel=\"external_link\" target=\"_blank\">tendons<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arteries\" class=\"mw-redirect\" title=\"Arteries\" rel=\"external_link\" target=\"_blank\">arteries<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Muscle\" title=\"Muscle\" rel=\"external_link\" target=\"_blank\">muscle<\/a> strips and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nerves\" class=\"mw-redirect\" title=\"Nerves\" rel=\"external_link\" target=\"_blank\">nerves<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silk\" title=\"Silk\" rel=\"external_link\" target=\"_blank\">silk<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut\" title=\"Catgut\" rel=\"external_link\" target=\"_blank\">catgut<\/a>).\n<\/p><p>The earliest reports of surgical suture date to 3000 BC in ancient <a href=\"https:\/\/en.wikipedia.org\/wiki\/Egypt\" title=\"Egypt\" rel=\"external_link\" target=\"_blank\">Egypt<\/a>, and the oldest known suture is in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mummy\" title=\"Mummy\" rel=\"external_link\" target=\"_blank\">mummy<\/a> from 1100 BC. A detailed description of a wound suture and the suture materials used in it is by the Indian sage and physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sushruta_Samhita\" title=\"Sushruta Samhita\" rel=\"external_link\" target=\"_blank\">Sushruta<\/a>, written in 500 BC.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> The Greek father of medicine, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hippocrates\" title=\"Hippocrates\" rel=\"external_link\" target=\"_blank\">Hippocrates<\/a>, described suture techniques, as did the later Roman <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aulus_Cornelius_Celsus\" title=\"Aulus Cornelius Celsus\" rel=\"external_link\" target=\"_blank\">Aulus Cornelius Celsus<\/a>. The 2nd-century Roman physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Galen\" title=\"Galen\" rel=\"external_link\" target=\"_blank\">Galen<\/a> described gut sutures.<sup id=\"rdp-ebb-cite_ref-Nutton2005_24-0\" class=\"reference\"><a href=\"#cite_note-Nutton2005-24\" rel=\"external_link\">[24]<\/a><\/sup> In the 10th century, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut_suture\" title=\"Catgut suture\" rel=\"external_link\" target=\"_blank\">catgut suture<\/a> along with the surgery needle were developed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abulcasis\" class=\"mw-redirect\" title=\"Abulcasis\" rel=\"external_link\" target=\"_blank\">Abulcasis<\/a><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup>. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut_suture\" title=\"Catgut suture\" rel=\"external_link\" target=\"_blank\">catgut suture<\/a> was similar to that of strings for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Violin\" title=\"Violin\" rel=\"external_link\" target=\"_blank\">violins<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Guitar\" title=\"Guitar\" rel=\"external_link\" target=\"_blank\">guitar<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tennis_racquet\" class=\"mw-redirect\" title=\"Tennis racquet\" rel=\"external_link\" target=\"_blank\">tennis racquet<\/a> and it involved harvesting sheep <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intestine\" class=\"mw-redirect\" title=\"Intestine\" rel=\"external_link\" target=\"_blank\">intestines<\/a>.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Joseph_Lister,_1st_Baron_Lister\" class=\"mw-redirect\" title=\"Joseph Lister, 1st Baron Lister\" rel=\"external_link\" target=\"_blank\">Joseph Lister<\/a> endorsed the routine <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">sterilization<\/a> of all suture threads. He first attempted sterilization with the 1860s \"carbolic catgut,\" and chromic catgut followed two decades later. Sterile catgut was finally achieved in 1906 with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iodine\" title=\"Iodine\" rel=\"external_link\" target=\"_blank\">iodine<\/a> treatment.\n<\/p><p>The next great leap came in the twentieth century. The chemical industry drove production of the first synthetic thread in the early 1930s, which exploded into production of numerous absorbable and non-absorbable synthetics. The first synthetic absorbable was based on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyvinyl_alcohol\" title=\"Polyvinyl alcohol\" rel=\"external_link\" target=\"_blank\">polyvinyl alcohol<\/a> in 1931. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyester\" title=\"Polyester\" rel=\"external_link\" target=\"_blank\">Polyesters<\/a> were developed in the 1950s, and later the process of radiation sterilization was established for catgut and polyester. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolic_acid\" class=\"mw-redirect\" title=\"Polyglycolic acid\" rel=\"external_link\" target=\"_blank\">Polyglycolic acid<\/a> was discovered in the 1960s and implemented in the 1970s. Today, most sutures are made of synthetic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polymer\" title=\"Polymer\" rel=\"external_link\" target=\"_blank\">polymer<\/a> fibers. Silk and, rarely, gut sutures are the only materials still in use from ancient times. In fact, gut sutures have been banned in Europe and Japan owing to concerns regarding <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bovine_Spongiform_Encephalopathy\" class=\"mw-redirect\" title=\"Bovine Spongiform Encephalopathy\" rel=\"external_link\" target=\"_blank\">Bovine Spongiform Encephalopathy<\/a>. Silk suture is still used, mainly to secure surgical drains.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Alexis_Carrel\" title=\"Alexis Carrel\" rel=\"external_link\" target=\"_blank\">Alexis Carrel<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Barbed_suture\" title=\"Barbed suture\" rel=\"external_link\" target=\"_blank\">Barbed suture<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Butterfly_closure\" class=\"mw-redirect\" title=\"Butterfly closure\" rel=\"external_link\" target=\"_blank\">Butterfly closure<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cheesewiring\" title=\"Cheesewiring\" rel=\"external_link\" target=\"_blank\">Cheesewiring<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Chitin\" title=\"Chitin\" rel=\"external_link\" target=\"_blank\">Chitin<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cyanoacrylate\" title=\"Cyanoacrylate\" rel=\"external_link\" target=\"_blank\">Cyanoacrylate<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Knot\" title=\"Knot\" rel=\"external_link\" target=\"_blank\">Knots<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ligature_(medicine)\" title=\"Ligature (medicine)\" rel=\"external_link\" target=\"_blank\">Ligature<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_medical_topics\" class=\"mw-redirect\" title=\"List of medical topics\" rel=\"external_link\" target=\"_blank\">List of medical topics<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sewing\" title=\"Sewing\" rel=\"external_link\" target=\"_blank\">Sewing<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_staple\" title=\"Surgical staple\" rel=\"external_link\" target=\"_blank\">Surgical staple<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wound_closure_strip\" title=\"Wound closure strip\" rel=\"external_link\" target=\"_blank\">Wound closure strips<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ethicon.novartis.us\/pdf\/finalNeedleDetailer.pdf\" target=\"_blank\">Surgical Needle Guide<\/a> from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Novartis\" title=\"Novartis\" rel=\"external_link\" target=\"_blank\">Novartis<\/a>. Copyright 2005.<\/span>\n<\/li>\n<li id=\"cite_note-SutureTypes-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SutureTypes_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.dolphinsutures.com\/types-of-sutures\" target=\"_blank\">\"Types of Sutures\"<\/a>. Dolphin Sutures<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-01-07<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Types+of+Sutures&rft.pub=Dolphin+Sutures&rft_id=http%3A%2F%2Fwww.dolphinsutures.com%2Ftypes-of-sutures&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">ETHICON Products (20 December 2002). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.prnewswire.com\/news-releases\/ethicon-receives-fda-clearance-to-market-vicryl-plus-first-ever-antibacterial-suture-77230792.html\" target=\"_blank\">\"ETHICON Receives FDA Clearance to Market VICRYL* Plus, First Ever Antibacterial Suture\"<\/a>. PRNewswire<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">25 January<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=ETHICON+Receives+FDA+Clearance+to+Market+VICRYL%2A+Plus%2C+First+Ever+Antibacterial+Suture&rft.date=2002-12-20&rft.au=ETHICON+Products&rft_id=http%3A%2F%2Fwww.prnewswire.com%2Fnews-releases%2Fethicon-receives-fda-clearance-to-market-vicryl-plus-first-ever-antibacterial-suture-77230792.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Daoud, FC; Edmiston CE, Jr; Leaper, D (June 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4063374\" target=\"_blank\">\"Meta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: robustness to new evidence\"<\/a>. <i>Surgical infections<\/i>. <b>15<\/b> (3): 165\u201381. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1089%2Fsur.2013.177\" target=\"_blank\">10.1089\/sur.2013.177<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4063374\" target=\"_blank\">4063374<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24738988\" target=\"_blank\">24738988<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Surgical+infections&rft.atitle=Meta-analysis+of+prevention+of+surgical+site+infections+following+incision+closure+with+triclosan-coated+sutures%3A+robustness+to+new+evidence.&rft.volume=15&rft.issue=3&rft.pages=165-81&rft.date=2014-06&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4063374&rft_id=info%3Apmid%2F24738988&rft_id=info%3Adoi%2F10.1089%2Fsur.2013.177&rft.aulast=Daoud&rft.aufirst=FC&rft.au=Edmiston+CE%2C+Jr&rft.au=Leaper%2C+D&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4063374&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">H\u00f6glund, Odd Viking (2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pub.epsilon.slu.se\/8589\/1\/odd_v_hoglund_120210..pdf\" target=\"_blank\"><i>A resorbable device for ligation of blood vessels : development, assessment of surgical procedures and clinical evaluation<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. pp. 17\u201319. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-91-576-7686-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=A+resorbable+device+for+ligation+of+blood+vessels+%3A+development%2C+assessment+of+surgical+procedures+and+clinical+evaluation&rft.pages=17-19&rft.date=2012&rft.isbn=978-91-576-7686-3&rft.aulast=H%C3%B6glund&rft.aufirst=Odd+Viking&rft_id=http%3A%2F%2Fpub.epsilon.slu.se%2F8589%2F1%2Fodd_v_hoglund_120210..pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/teachmesurgery.com\/skills\/theatre-basics\/suture-materials\/\" target=\"_blank\">\"Suture Materials - Classification - Surgical Needles - TeachMeSurgery\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Suture+Materials+-+Classification+-+Surgical+Needles+-+TeachMeSurgery&rft_id=http%3A%2F%2Fteachmesurgery.com%2Fskills%2Ftheatre-basics%2Fsuture-materials%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">H\u00f6glund, Odd Viking (2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pub.epsilon.slu.se\/8589\/1\/odd_v_hoglund_120210..pdf\" target=\"_blank\"><i>A resorbable device for ligation of blood vessels : development, assessment of surgical procedures and clinical evaluation<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-91-576-7686-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=A+resorbable+device+for+ligation+of+blood+vessels+%3A+development%2C+assessment+of+surgical+procedures+and+clinical+evaluation&rft.date=2012&rft.isbn=978-91-576-7686-3&rft.aulast=H%C3%B6glund&rft.aufirst=Odd+Viking&rft_id=http%3A%2F%2Fpub.epsilon.slu.se%2F8589%2F1%2Fodd_v_hoglund_120210..pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">H\u00f6glund, Odd V; Ingman, Jessica; S\u00f6dersten, Fredrik; Hansson, Kerstin; Borg, Niklas; Lagerstedt, Anne-Sofie (2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bmcresnotes.biomedcentral.com\/articles\/10.1186\/1756-0500-7-825\" target=\"_blank\">\"Ligation of the spermatic cord in dogs with a self-locking device of a resorbable polyglycolic based co-polymer \u2013 feasibility and long-term follow-up study\"<\/a>. <i>BMC Research Notes<\/i>. <b>7<\/b> (1): 825. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2F1756-0500-7-825\" target=\"_blank\">10.1186\/1756-0500-7-825<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMC+Research+Notes&rft.atitle=Ligation+of+the+spermatic+cord+in+dogs+with+a+self-locking+device+of+a+resorbable+polyglycolic+based+co-polymer+%E2%80%93+feasibility+and+long-term+follow-up+study&rft.volume=7&rft.issue=1&rft.pages=825&rft.date=2014&rft_id=info%3Adoi%2F10.1186%2F1756-0500-7-825&rft.aulast=H%C3%B6glund&rft.aufirst=Odd+V&rft.au=Ingman%2C+Jessica&rft.au=S%C3%B6dersten%2C+Fredrik&rft.au=Hansson%2C+Kerstin&rft.au=Borg%2C+Niklas&rft.au=Lagerstedt%2C+Anne-Sofie&rft_id=http%3A%2F%2Fbmcresnotes.biomedcentral.com%2Farticles%2F10.1186%2F1756-0500-7-825&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hjort, H.; Mathisen, T.; Alves, A.; Clermont, G.; Boutrand, J. P. (5 October 2011). \"Three-year results from a preclinical implantation study of a long-term resorbable surgical mesh with time-dependent mechanical characteristics\". <i>Hernia<\/i>. <b>16<\/b> (2): 191\u2013197. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs10029-011-0885-y\" target=\"_blank\">10.1007\/s10029-011-0885-y<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Hernia&rft.atitle=Three-year+results+from+a+preclinical+implantation+study+of+a+long-term+resorbable+surgical+mesh+with+time-dependent+mechanical+characteristics&rft.volume=16&rft.issue=2&rft.pages=191-197&rft.date=2011-10-05&rft_id=info%3Adoi%2F10.1007%2Fs10029-011-0885-y&rft.aulast=Hjort&rft.aufirst=H.&rft.au=Mathisen%2C+T.&rft.au=Alves%2C+A.&rft.au=Clermont%2C+G.&rft.au=Boutrand%2C+J.+P.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Anderson, James M.; Rodriguez, Analiz; Chang, David T. (April 2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2327202\" target=\"_blank\">\"Foreign body reaction to biomaterials\"<\/a>. <i>Seminars in Immunology<\/i>. <b>20<\/b> (2): 86\u2013100. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.smim.2007.11.004\" target=\"_blank\">10.1016\/j.smim.2007.11.004<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2327202\" target=\"_blank\">2327202<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Seminars+in+Immunology&rft.atitle=Foreign+body+reaction+to+biomaterials&rft.volume=20&rft.issue=2&rft.pages=86-100&rft.date=2008-04&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2327202&rft_id=info%3Adoi%2F10.1016%2Fj.smim.2007.11.004&rft.aulast=Anderson&rft.aufirst=James+M.&rft.au=Rodriguez%2C+Analiz&rft.au=Chang%2C+David+T.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2327202&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-rh-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-rh_11-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Lammers, Richard L; Trott, Alexander T (2004). \"Chapter 36: Methods of Wound Closure\". In Roberts, James R; Hedges, Jerris R. <i>Clinical Procedures in Emergency Medicine<\/i> (4th ed.). Philadelphia: Saunders. p. 671. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-7216-9760-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+36%3A+Methods+of+Wound+Closure&rft.btitle=Clinical+Procedures+in+Emergency+Medicine&rft.place=Philadelphia&rft.pages=671&rft.edition=4th&rft.pub=Saunders&rft.date=2004&rft.isbn=0-7216-9760-7&rft.aulast=Lammers&rft.aufirst=Richard+L&rft.au=Trott%2C+Alexander+T&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Dorland's Medical Dictionary for Health Consumers. Copyright 2007<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Miller-Keane_Encyclopedia_%26_Dictionary_of_Medicine,_Nursing,_and_Allied_Health\" title=\"Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health\" rel=\"external_link\" target=\"_blank\">Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health<\/a>, Seventh Edition.<\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Osterberg, B; Blomstedt, B (1979). \"Effect of suture materials on bacterial survival in infected wounds: An experimental study\". <i>Acta Chir Scand<\/i>. <b>145<\/b>: 431.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Chir+Scand&rft.atitle=Effect+of+suture+materials+on+bacterial+survival+in+infected+wounds%3A+An+experimental+study&rft.volume=145&rft.pages=431&rft.date=1979&rft.aulast=Osterberg&rft.aufirst=B&rft.au=Blomstedt%2C+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-macht-15\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-macht_15-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-macht_15-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Macht, SD; Krizek, TJ (1978). \"Sutures and suturing - Current concepts\". <i>Journal of Oral Surgery<\/i>. <b>36<\/b>: 710.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Oral+Surgery&rft.atitle=Sutures+and+suturing+-+Current+concepts&rft.volume=36&rft.pages=710&rft.date=1978&rft.aulast=Macht&rft.aufirst=SD&rft.au=Krizek%2C+TJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-kirk-16\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-kirk_16-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-kirk_16-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Kirk, RM (1978). <i>Basic Surgical Techniques<\/i>. Edinburgh: Churchill Livingstone.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Basic+Surgical+Techniques&rft.place=Edinburgh&rft.pub=Churchill+Livingstone&rft.date=1978&rft.aulast=Kirk&rft.aufirst=RM&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Grossman, JA (1982). \"The repair of surface trauma\". <i>Emergency Medicine<\/i>. <b>14<\/b>: 220.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Emergency+Medicine&rft.atitle=The+repair+of+surface+trauma&rft.volume=14&rft.pages=220&rft.date=1982&rft.aulast=Grossman&rft.aufirst=JA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Varshney, S; Manek, P; Johnson, CD (September 1999). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2503300\" target=\"_blank\">\"Six-fold suture:wound length ratio for abdominal closure\"<\/a>. <i>Annals of the Royal College of Surgeons of England<\/i>. <b>81<\/b> (5): 333\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2503300\" target=\"_blank\">2503300<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10645176\" target=\"_blank\">10645176<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+the+Royal+College+of+Surgeons+of+England&rft.atitle=Six-fold+suture%3Awound+length+ratio+for+abdominal+closure.&rft.volume=81&rft.issue=5&rft.pages=333-6&rft.date=1999-09&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2503300&rft_id=info%3Apmid%2F10645176&rft.aulast=Varshney&rft.aufirst=S&rft.au=Manek%2C+P&rft.au=Johnson%2C+CD&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2503300&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Stark, M.; Chavkin, Y.; Kupfersztain, C.; Guedj, P.; Finkel, A. R. (1995). \"Evaluation of combinations of procedures in cesarean section\". <i>International Journal of Gynecology & Obstetrics<\/i>. <b>48<\/b> (3): 273\u20136. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0020-7292%2894%2902306-J\" target=\"_blank\">10.1016\/0020-7292(94)02306-J<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7781869\" target=\"_blank\">7781869<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Gynecology+%26+Obstetrics&rft.atitle=Evaluation+of+combinations+of+procedures+in+cesarean+section&rft.volume=48&rft.issue=3&rft.pages=273-6&rft.date=1995&rft_id=info%3Adoi%2F10.1016%2F0020-7292%2894%2902306-J&rft_id=info%3Apmid%2F7781869&rft.aulast=Stark&rft.aufirst=M.&rft.au=Chavkin%2C+Y.&rft.au=Kupfersztain%2C+C.&rft.au=Guedj%2C+P.&rft.au=Finkel%2C+A.+R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.scribd.com\/doc\/127263916\/Bedah-Minor\" target=\"_blank\">\"www.scribd.com\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=www.scribd.com&rft_id=https%3A%2F%2Fwww.scribd.com%2Fdoc%2F127263916%2FBedah-Minor&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-bard-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-bard_21-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bardpv.com\/_vascular\/product.php?p=31\" target=\"_blank\">\"Polytetrafluoroethylene Pledget\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Polytetrafluoroethylene+Pledget&rft_id=http%3A%2F%2Fwww.bardpv.com%2F_vascular%2Fproduct.php%3Fp%3D31&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Dumville, JC; Coulthard, P; Worthington, HV; Riley, P; Patel, N; Darcey, J; Esposito, M; van der Elst, M; van Waes, OJ (28 November 2014). \"Tissue adhesives for closure of surgical incisions\". <i>The Cochrane Database of Systematic Reviews<\/i>. <b>11<\/b>: CD004287. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.CD004287.pub4\" target=\"_blank\">10.1002\/14651858.CD004287.pub4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25431843\" target=\"_blank\">25431843<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Tissue+adhesives+for+closure+of+surgical+incisions.&rft.volume=11&rft.pages=CD004287&rft.date=2014-11-28&rft_id=info%3Adoi%2F10.1002%2F14651858.CD004287.pub4&rft_id=info%3Apmid%2F25431843&rft.aulast=Dumville&rft.aufirst=JC&rft.au=Coulthard%2C+P&rft.au=Worthington%2C+HV&rft.au=Riley%2C+P&rft.au=Patel%2C+N&rft.au=Darcey%2C+J&rft.au=Esposito%2C+M&rft.au=van+der+Elst%2C+M&rft.au=van+Waes%2C+OJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Mysore, Venkataram. <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=sushruta&f=false\"><i>Acs(I) Textbook on Cutaneous and Aesthetic Surgery<\/i><\/a>. Jaypee Brothers Medical Publishers Pvt. Ltd. pp. 125\u2013126. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9789350905913<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">25 January<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Acs%28I%29+Textbook+on+Cutaneous+and+Aesthetic+Surgery&rft.pages=125-126&rft.pub=Jaypee+Brothers+Medical+Publishers+Pvt.+Ltd.&rft.isbn=9789350905913&rft.aulast=Mysore&rft.aufirst=Venkataram&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D47HGBAAAQBAJ%26lpg%3DPA125%26pg%3DPA126%23v%3Donepage%26q%3Dsushruta%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Nutton2005-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Nutton2005_24-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Nutton, Dr Vivia (2005-07-30). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=PREr9_rojrQC\" target=\"_blank\"><i>Ancient Medicine<\/i><\/a>. Taylor & Francis US. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780415368483<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">21 November<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Ancient+Medicine&rft.pub=Taylor+%26+Francis+US&rft.date=2005-07-30&rft.isbn=9780415368483&rft.aulast=Nutton&rft.aufirst=Dr+Vivia&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DPREr9_rojrQC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Rooney, Anne (2009). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=false\"><i>The Story of Medicine<\/i><\/a>. Arcturus Publishing. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781848580398.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Story+of+Medicine&rft.pub=Arcturus+Publishing&rft.date=2009&rft.isbn=9781848580398&rft.aulast=Rooney&rft.aufirst=Anne&rft_id=https%3A%2F%2Fbooks.google.com.sa%2Fbooks%3Fid%3DjBMEAwAAQBAJ%26pg%3DPT161%26dq%3DCatgut%2Bal-zahrawi%2BThe%2BStory%2Bof%2BMedicine%26hl%3Den%26sa%3DX%26ved%3D0ahUKEwiFg53yt_XZAhWEPRQKHTkSB1AQ6AEIMzAC%23v%3Donepage%26q%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Rakel, David; Rakel, Robert E. (2011). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=Abulcasis%20%22surgical%20needle%22&f=false\"><i>Textbook of Family Medicine E-Book<\/i><\/a>. Elsevier Health Sciences. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1437735673.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Textbook+of+Family+Medicine+E-Book&rft.pub=Elsevier+Health+Sciences&rft.date=2011&rft.isbn=1437735673&rft.aulast=Rakel&rft.aufirst=David&rft.au=Rakel%2C+Robert+E.&rft_id=https%3A%2F%2Fbooks.google.com.sa%2Fbooks%3Fid%3DB3Hr25rgpZsC%26pg%3DPA550-IA11%26dq%3DAbulcasis%2B%2522plastic%2Bsurgery%2522%26hl%3Den%26sa%3DX%26ved%3D0ahUKEwi_mJna5ffZAhWCtBQKHWJ_Cc4Q6AEILDAB%23v%3Donepage%26q%3DAbulcasis%2520%2522surgical%2520needle%2522%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+suture\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Commons-logo.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/12px-Commons-logo.svg.png\" width=\"12\" height=\"16\" class=\"noviewer\" \/><\/a> Media related to <a href=\"https:\/\/commons.wikimedia.org\/wiki\/Category:Surgical_suture\" class=\"extiw\" title=\"commons:Category:Surgical suture\" rel=\"external_link\" target=\"_blank\">Surgical suture <\/a> at Wikimedia Commons\n<\/p>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.researchgate.net\/publication\/262529587_Sutured_tendon_repair_a_multi-scale_finite_element_model\" target=\"_blank\">Computer modelling of sutures<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1275\nCached time: 20181212170216\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.396 seconds\nReal time usage: 0.541 seconds\nPreprocessor visited node count: 1758\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 50735\/2097152 bytes\nTemplate argument size: 733\/2097152 bytes\nHighest expansion depth: 10\/40\nExpensive parser function count: 4\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 66925\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.197\/10.000 seconds\nLua memory usage: 5.82 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 463.253 1 -total\n<\/p>\n<pre>41.93% 194.264 1 Template:Reflist\n14.49% 67.112 4 Template:Cite_web\n14.46% 67.007 1 Template:Infobox_medical_intervention\n13.53% 62.685 1 Template:Infobox\n13.00% 60.200 10 Template:Cite_journal\n12.02% 55.704 1 Template:Commonscatinline\n10.43% 48.306 1 Template:Globalize\/US\n 9.12% 42.256 1 Template:Globalize\n 8.20% 37.983 1 Template:Ambox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:13896574-1!canonical and timestamp 20181212170216 and revision id 865977170\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214707\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.177 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 169.860 1 - wikipedia:Surgical_suture\n100.00% 169.860 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8264-0!*!*!*!*!*!* and timestamp 20181217214707 and revision id 24474\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_suture#Techniques\">https:\/\/www.limswiki.org\/index.php\/Surgical_suture#Techniques<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","3014f54069aaa56a07a85b820a8b84f8_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e9\/Atraumatisches_Nahtmaterial_17.JPG\/560px-Atraumatisches_Nahtmaterial_17.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3a\/HechtnaaldenB.jpg\/240px-HechtnaaldenB.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/HechtnaaldenG.jpg\/240px-HechtnaaldenG.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9e\/Suture_micrograph.jpg\/440px-Suture_micrograph.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4e\/12_Stitches.jpg\/440px-12_Stitches.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/0\/07\/Suture%2C_before_and_after%2C_RMO.jpg\/440px-Suture%2C_before_and_after%2C_RMO.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/70\/ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara%2C_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif\/lossy-page1-440px-ASC_Leiden_-_Coutinho_Collection_-_A_37_-_Surgery_in_Sara%2C_Guinea-Bissau_-_Suturing_the_wound_-_1974.tif.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/57\/C._Stromayr%3B_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg\/440px-C._Stromayr%3B_Sewing_wound_after_herniotomy._1559_Wellcome_M0010186.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bf\/Surgical_thread_supplier_1.jpg\/340px-Surgical_thread_supplier_1.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/24px-Commons-logo.svg.png"],"3014f54069aaa56a07a85b820a8b84f8_timestamp":1545083227,"7be8ae6a8cc61a682af74f5c8f893873_type":"article","7be8ae6a8cc61a682af74f5c8f893873_title":"Robot-assisted surgery","7be8ae6a8cc61a682af74f5c8f893873_url":"https:\/\/www.limswiki.org\/index.php\/Robot-assisted_surgery","7be8ae6a8cc61a682af74f5c8f893873_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tRobot-assisted surgery\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\n\n A robotically assisted surgical system used for prostatectomies, cardiac valve repair and gynecologic surgical procedures\nRobotic surgery, computer-assisted surgery, and robotically-assisted surgery are terms for technological developments that use robotic systems to aid in surgical procedures. Robotically-assisted surgery was developed to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabilities of surgeons performing open surgery.\nIn the case of robotically-assisted minimally-invasive surgery, instead of directly moving the instruments, the surgeon uses one of two methods to control the instruments; either a direct telemanipulator or through computer control. A telemanipulator is a remote manipulator that allows the surgeon to perform the normal movements associated with the surgery whilst the robotic arms carry out those movements using end-effectors and manipulators to perform the actual surgery on the patient. In computer-controlled systems the surgeon uses a computer to control the robotic arms and its end-effectors, though these systems can also still use telemanipulators for their input. One advantage of using the computerised method is that the surgeon does not have to be present, but can be anywhere in the world, leading to the possibility for remote surgery.\nIn the case of enhanced open surgery, autonomous instruments (in familiar configurations) replace traditional steel tools, performing certain actions (such as rib spreading) with much smoother, feedback-controlled motions than could be achieved by a human hand. The main object of such smart instruments is to reduce or eliminate the tissue trauma traditionally associated with open surgery without requiring more than a few minutes' training on the part of surgeons. This approach seeks to improve open surgeries, particularly cardio-thoracic, that have so far not benefited from minimally-invasive techniques.\nRobotic surgery has been criticized for its expense, by one estimate costing $1,500 to $2000 more per patient.[1]\n\nContents \n\n1 Comparison to traditional methods \n2 Uses \n\n2.1 Cardiology and electrophysiology \n2.2 Colon and rectal surgery \n2.3 Gastrointestinal surgery \n2.4 Gynecology \n2.5 Orthopedics \n2.6 Children \n2.7 Spine surgery \n2.8 Transplant surgery \n2.9 Urology \n\n\n3 History \n4 See also \n5 References \n6 External links \n\n\nComparison to traditional methods \nMajor advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery. Due to robotic use, the surgery is done with precision, miniaturization, smaller incisions; decreased blood loss, less pain, and quicker healing time. Articulation beyond normal manipulation and three-dimensional magnification helps resulting in improved ergonomics. Due to these techniques there is a reduced duration of hospital stays, blood loss, transfusions, and use of pain medication.[2]\nThe existing open surgery technique has many flaws like limited access to surgical area, long recovery time, long hours of operation, blood loss, surgical scars and marks.[3]\nThe robot normally costs $1,390,000 and while its disposable supply cost is normally $1,500 per procedure, the cost of the procedure is higher.[1] Additional surgical training is needed to operate the system.[4] Numerous feasibility studies have been done to determine whether the purchase of such systems are worthwhile. As it stands, opinions differ dramatically. Surgeons report that, although the manufacturers of such systems provide training on this new technology, the learning phase is intensive and surgeons must operate on twelve to eighteen patients before they adapt. During the training phase, minimally invasive operations can take up to twice as long as traditional surgery, leading to operating room tie ups and surgical staffs keeping patients under anesthesia for longer periods. Patient surveys indicate they chose the procedure based on expectations of decreased morbidity, improved outcomes, reduced blood loss and less pain.[2] Higher expectations may explain higher rates of dissatisfaction and regret.[4]\nCompared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not tire as quickly. Naturally occurring hand tremors are filtered out by the robot's computer software. Finally, the surgical robot can continuously be used by rotating surgery teams.[5]\nCritics of the system, including the American Congress of Obstetricians and Gynecologists,[6] say there is a steep learning curve for surgeons who adopt use of the system and that there's a lack of studies that indicate long-term results are superior to results following traditional laparoscopic surgery.[1] Articles in the newly created Journal of Robotic Surgery tend to report on one surgeon's experience.[1]\nA Medicare study found that some procedures that have traditionally been performed with large incisions can be converted to \"minimally invasive\" endoscopic procedures with the use of the Da Vinci Surgical System, shortening length-of-stay in the hospital and reducing recovery times. But because of the hefty cost of the robotic system it is not clear that it is cost-effective for hospitals and physicians despite any benefits to patients since there is no additional reimbursement paid by the government or insurance companies when the system is used.[1]\nRobot-assisted pancreatectomies have been found to be associated with \"longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay[s]\" than laparoscopic pancreatectomies; there was \"no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.\"[7] For surgical removal of the uterus and cervix for early cervical cancer robotic and laparoscopic surgery resulted in similar outcomes with respect to the cancer.[8]\n\nUses \nCardiology and electrophysiology \nAs of 2004, three types of heart surgery are being performed on a routine basis using robotic surgery systems.[9] These three surgery types were:\n\nAtrial septal defect repair \u2013 the repair of a hole between the two upper chambers of the heart,\nMitral valve repair \u2013 the repair of the valve that prevents blood from regurgitating back into the upper heart chambers during contractions of the heart,\nCoronary artery bypass \u2013 rerouting of blood supply by bypassing blocked arteries that provide blood to the heart.\nColon and rectal surgery \nMany studies have been undertaken in order to examine the role of robotic procedures in the field of colorectal surgery.[10][11]\nResults to date indicate that robotic-assisted colorectal procedures outcomes are \"no worse\" than the results in the now \"traditional\" laparoscopic colorectal operations. Robotic-assisted colorectal surgery appears to be safe as well.[12] Most of the procedures have been performed for malignant colon and rectal lesions. However, surgeons are now moving into resections for diverticulitis and non-resective rectopexies (attaching the colon to the sacrum in order to treat rectal prolapse.)\nWhen evaluated for several variables, robotic-assisted procedures fare equally well when compared with laparoscopic, or open abdominal operations. Study parameters have looked at intraoperative patient preparation time, length of time to perform the operation, adequacy of the removed surgical specimen with respect to clear surgical margins and number of lymph nodes removed, blood loss, operative or postoperative complications and long-term results.\nMore difficult to evaluate are issues related to the view of the operative field, the types of procedures that should be performed using robotic assistance and the potential added cost for a robotic operation.\nMany surgeons feel that the optics of the 3-dimensional, two camera stereo optic robotic system are superior to the optical system used in laparoscopic procedures. The pelvic nerves are clearly visualized during robotic-assisted procedures. Less clear however is whether or not these supposedly improved optics and visualization improve patient outcomes with respect to postoperative impotence or incontinence, and whether long-term patient survival is improved by using the 3-dimensional optic system. Additionally, there is often a need for a wider, or \"larger\" view of the operative field than is routinely provided during robotic operations.,[13] The close-up view of the area under dissection may hamper visualization of the \"bigger view\", especially with respect to ureteral protection.\nQuestions remain unanswered, even after many years of experience with robotic-assisted colorectal operations. Ongoing studies may help clarify many of the issues of confusion associated with this novel surgical approach.\n\nGastrointestinal surgery \nMultiple types of procedures have been performed with either the 'Zeus' or da Vinci robot systems, including bariatric surgery and gastrectomy[14] for cancer. Surgeons at various universities initially published case series demonstrating different techniques and the feasibility of GI surgery using the robotic devices.[15] Specific procedures have been more fully evaluated, specifically esophageal fundoplication for the treatment of gastroesophageal reflux[16] and Heller myotomy for the treatment of achalasia.[17][18]\nOther gastrointestinal procedures including colon resection, pancreatectomy, esophagectomy and robotic approaches to pelvic disease have also been reported.\n\nGynecology \nRobotic surgery in gynecology is of uncertain benefit with it being unclear if it affects rates of complications. Gynecologic procedures may take longer with robot-assisted surgery but may be associated with a shorter hospital stay following hysterectomy.[19] In the United States, robotic-assisted hysterectomy for benign conditions has been shown to be more expensive than conventional laparoscopic hysterectomy, with no difference in overall rates of complications.[20]\nThis includes the use of the da Vinci surgical system in benign gynecology and gynecologic oncology. Robotic surgery can be used to treat fibroids, abnormal periods, endometriosis, ovarian tumors, uterine prolapse, and female cancers. Using the robotic system, gynecologists can perform hysterectomies, myomectomies, and lymph node biopsies.\n\nOrthopedics \nRobots are used in orthopedic surgery.[21]\n\nChildren \nSurgical robotics has been used in many types of pediatric surgical procedures including: tracheoesophageal fistula repair, cholecystectomy, nissen fundoplication, morgagni's hernia repair, kasai portoenterostomy, congenital diaphragmatic hernia repair, and others.[citation needed ]\n\nSpine surgery \nRobotic devices started to be used in minimally invasive spine surgery starting in the mid-2000s.[22] As of 2014, there were too few randomized clinical trials to allow judgements as to whether robotic spine surgery is more or less safe than other approaches.[22]\n\nTransplant surgery \nTransplant surgery (organ transplantation) has been considered as highly technically demanding and virtually unobtainable by means of conventional laparoscopy. For many years, transplant patients were unable to benefit from the advantages of minimally invasive surgery. The development of robotic technology and its associated high resolution capabilities, three dimensional visual system, wrist type motion and fine instruments, gave opportunity for highly complex procedures to be completed in a minimally invasive fashion. Subsequently, the first fully robotic kidney transplantations were performed in the late 2000s. After the procedure was proven to be feasible and safe, the main emerging challenge was to determine which patients would benefit most from this robotic technique. As a result, recognition of the increasing prevalence of obesity amongst patients with kidney failure on hemodialysis posed a significant problem. Due to the abundantly higher risk of complications after traditional open kidney transplantation, obese patients were frequently denied access to transplantation, which is the premium treatment for end stage kidney disease.[citation needed ]\n\nUrology \nRobotic surgery in the field of urology has become very popular, especially in the United States.[23] It has been most extensively applied for excision of prostate cancer because of difficult anatomical access. It is also utilized for kidney cancer surgeries and to lesser extent surgeries of the bladder.\nAs of 2014, there is little evidence of increased benefits compared to standard surgery to justify the increased costs.[24] Some have found tentative evidence of more complete removal of cancer and less side effects from surgery for prostatectomy.[25]\nIn 2000, the first robot-assisted laparoscopic radical prostatectomy was performed.[4]\nBreast Surgery\nRobotic breast surgery involves using the robot to assist in performing nipple-sparing mastectomy and breast reconstruction. In 2015, a group of surgeons led by Dr. Antonio Toesca, in Milan, Italy demonstrated the feasibility and safety of robotic nipple-sparing mastectomy and robotic breast reconstruction.[26] The Italian surgeons published their results in their first 29 consecutive patients. In this report, all patients had robotic mastectomy and reconstruction done through a 3 cm extra-mammary incision, hidden by the arm. Thereafter, a surgeon, Dr. Benjamin Sarfati, in Paris began performing robotic mastectomy and breast reconstruction.[27] On March 4, 2018, Dr. Neil Tanna and colleagues performed the first robotic nipple-sparing mastectomy and robotic breast reconstruction in North America.[28][29] \nTraditional (open) nipple-sparing mastectomy and breast reconstruction require incisions on the breast. Robotic nipple sparing mastectomy with robotic breast reconstruction is an innovative form of breast surgery that utilizes robotic technology to perform the surgery. By using the robot, the incisions can be much smaller and be placed off the breasts, far away near the armpit or the bra line.\n\nHistory \nThe first robot to assist in surgery was the Arthrobot, which was developed and used for the first time in Vancouver in 1983.[30] Intimately involved were biomedical engineer Dr. James McEwen, Geof Auchinleck, a UBC engineering physics grad, and Dr. Brian Day as well as a team of engineering students. The robot was used in an orthopaedic surgical procedure on 12 March 1984, at the UBC Hospital in Vancouver. Over 60 arthroscopic surgical procedures were performed in the first 12 months, and a 1985 National Geographic video on industrial robots, The Robotics Revolution, featured the device. Other related robotic devices developed at the same time included a surgical scrub nurse robot, which handed operative instruments on voice command, and a medical laboratory robotic arm. A YouTube video entitled Arthrobot illustrates some of these in operation.[citation needed ]\nIn 1985 a robot, the Unimation Puma 200, was used to place a needle for a brain biopsy using CT guidance.[31] PROBOT was then used to perform prostatic surgery and ROBODOC to assist with hip replacement surgeries. The latter was the first surgical robot that was approved by the FDA.[32] The ROBODOC from Integrated Surgical Systems (working closely with IBM) was introduced in 1992 to mill out precise fittings in the femur for hip replacement.[33] The purpose of the ROBODOC was to replace the previous method of carving out a femur for an implant, the use of a mallet and broach\/rasp.\nFurther development of robotic systems was carried out by SRI International and Intuitive Surgical with the introduction of the da Vinci Surgical System and Computer Motion with the AESOP and the ZEUS robotic surgical system.[34] The first robotic surgery took place at The Ohio State University Medical Center in Columbus, Ohio under the direction of Robert E. Michler.[35] Examples of using ZEUS include a fallopian tube reconnection in July 1998,[36] a beating heart coronary artery bypass graft in October 1999,[37] and the Lindbergh Operation, which was a cholecystectomy performed remotely in September 2001.[38]\nThe original telesurgery robotic system that the da Vinci was based on was developed at SRI International in Menlo Park with grant support from DARPA and NASA.[39] Although the telesurgical robot was originally intended to facilitate remotely performed surgery in battlefield and other remote environments, it turned out to be more useful for minimally invasive on-site surgery. The patents for the early prototype were sold to Intuitive Surgical in Mountain View, California. The da Vinci senses the surgeon's hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. Examples of using the da Vinci system include the first robotically assisted heart bypass (performed in Germany) in May 1998, and the first performed in the United States in September 1999;[citation needed ] and the first all-robotic-assisted kidney transplant, performed in January 2009.[40] The da Vinci Si was released in April 2009, and initially sold for $1.75 million.[41]\nIn May 2006 the first artificial intelligence doctor-conducted unassisted robotic surgery was on a 34-year-old male to correct heart arrythmia. The results were rated as better than an above-average human surgeon. The machine had a database of 10,000 similar operations, and so, in the words of its designers, was \"more than qualified to operate on any patient\".[42][43] In August 2007, Dr. Sijo Parekattil of the Robotics Institute and Center for Urology (Winter Haven Hospital and University of Florida) performed the first robotic assisted microsurgery procedure denervation of the spermatic cord for chronic testicular pain.[44] In February 2008, Dr. Mohan S. Gundeti of the University of Chicago Comer Children's Hospital performed the first robotic pediatric neurogenic bladder reconstruction.[45]\nOn 12 May 2008, the first image-guided MR-compatible robotic neurosurgical procedure was performed at University of Calgary by Dr. Garnette Sutherland using the NeuroArm.[46] In June 2008, the German Aerospace Centre (DLR) presented a robotic system for minimally invasive surgery, the MiroSurge.[47] In September 2010, the Eindhoven University of Technology announced the development of the Sofie surgical system, the first surgical robot to employ force feedback.[48] In September 2010, the first robotic operation at the femoral vasculature was performed at the University Medical Centre Ljubljana by a team led by Borut Ger\u0161ak.[49][50]\n\nSee also \n\nBone segment navigation\nComputer-assisted surgery\nComputer-integrated surgery\nMinimally invasive surgery\nPatient registration\nStereolithography (medicine)\nSurgical Segment Navigator\nTelemedicine\nReferences \n\n\n^ a b c d e Kolata, Gina (13 February 2010). \"Results Unproven, Robotic Surgery Wins Converts\". The New York Times. Retrieved 11 March 2010 . \n\n^ a b Estey, EP (2009). \"Robotic prostatectomy: The new standard of care or a marketing success?\". Canadian Urological Association Journal. 3 (6): 488\u201390. PMC 2792423 . PMID 20019980. \n\n^ O'Toole, M. D.; Bouazza-Marouf, K.; Kerr, D.; Gooroochurn, M.; Vloeberghs, M. (2009). \"A methodology for design and appraisal of surgical robotic systems\". Robotica. 28 (2): 297\u2013310. doi:10.1017\/S0263574709990658. \n\n^ a b c Finkelstein J; Eckersberger E; Sadri H; Taneja SS; Lepor H; Djavan B (2010). \"Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US Experience\". Reviews in Urology. 12 (1): 35\u201343. PMC 2859140 . PMID 20428292. \n\n^ Gerhardus, D (July\u2013August 2003). \"Robot-assisted surgery: the future is here\". Journal of Healthcare Management. 48 (4): 242\u2013251. PMID 12908224. \n\n^ Breeden, James T., MD, President of ACOG, [1] Statement on Robotic Surgery, 14 March 2013 \n\n^ Zhou, JY; Xin, C; Mou, YP; Xu, XW; Zhang, MZ; Zhou, YC; Lu, C; Chen, RG (2016). \"Robotic versus Laparoscopic Distal Pancreatectomy: A Meta-Analysis of Short-Term Outcomes\". PLoS ONE. 11 (3): e0151189. Bibcode:2016PLoSO..1151189Z. doi:10.1371\/journal.pone.0151189. PMC 4790929 . PMID 26974961. \n\n^ Zanagnolo, V; Garbi, A; Achilarre, MT; Minig, L (16 January 2017). \"Robot-assisted surgery in Gynecologic cancers\". Journal of minimally invasive gynecology. 24: 379\u2013396. doi:10.1016\/j.jmig.2017.01.006. PMID 28104497. \n\n^ Kypson, Alan P; Chitwood Jr., W. Randolph (2004). \"Robotic Applications in Cardiac Surgery\". International Journal of Advanced Robotic Systems. 1 (2): 87\u201392. arXiv:cs\/0412055 . Bibcode:2004cs.......12055K. \n\n^ D'Annibale, A et al. Diseases of the Colon and Rectum. December 2004. Volume 47, issue 12, pp. 2162\u20132168 \n\n^ Spinoglio, G. Diseases of the Colon and Rectum. November 2008. Volume 51, issue 11, pp. 1627\u20131632 \n\n^ Delaney, C. et al. Diseases of the Colon and Rectum. December 2003. Volume 46, pp. 1633\u20131639 \n\n^ Braumann, C. et al. Diseases of the Colon and Rectum. December 2005. Volume 48, Number 9, pp1820-1827. \n\n^ Myung-Han, Hyun; Chung-Ho Lee; Hyun-Jung Kim; YiXin Tong; Sung-Soo Park (November 2013). \"Systematic review and meta-analysis of robotic surgery compared with conventional laparoscopic and open resection for gastric carcinoma\". British Journal of Surgery. 100 (12): 1566\u201378. doi:10.1002\/bjs.9242. PMID 24264778. \n\n^ Talamini, M. A.; Chapman, S.; Horgan, S.; Melvin, W. S. (October 2003). \"A prospective analysis of 211 robotic-assisted surgical procedures\". Surgical Endoscopy. 17 (10): 1521\u20131524. doi:10.1007\/s00464-002-8853-3. PMID 12915974. \n\n^ Melvin, W. Scott; Needleman, Bradley J.; Krause, Kevin R.; Schneider, Carol; Ellison, E. Christopher (2002). \"Computer-Enhanced vs. Standard Laparoscopic Antireflux Surgery\". Journal of Gastrointestinal Surgery. 6 (1): 11\u201315, discussion 15\u20136. doi:10.1016\/S1091-255X(01)00032-4. PMID 11986012. \n\n^ Melvin, W. S.; Dundon, J. M.; Talamini, M.; Horgan, S. (October 2005). \"Computer-enhanced robotic telesurgery minimizes esophageal perforation during Heller myotomy\". Surgery. 138 (4): 553\u2013558, discussion 558\u20139. doi:10.1016\/j.surg.2005.07.025. PMID 16269282. \n\n^ Shaligram A; Unnirevi J; Simorov A; Kothari VM; Oleynikov D (April 2012). \"How does the robot affect outcomes? A retrospective review of open, laparoscopic, and robotic Heller myotomy for achalasia\". Surgical Endoscopy. 26 (4): 1047\u201350. doi:10.1007\/s00464-011-1994-5. PMID 22038167. \n\n^ Liu, H; Lawrie, TA; Lu, D; Song, H; Wang, L; Shi, G (10 December 2014). \"Robot-assisted surgery in gynaecology\". The Cochrane Database of Systematic Reviews. 12 (12): CD011422. doi:10.1002\/14651858.CD011422. PMID 25493418. \n\n^ \"Committee Opinion: Robotic Surgery in Gynecolgy\". Obstetrics & Gynecology. 125 (3): 760\u2013767. March 2015. doi:10.1097\/01.AOG.0000461761.47981.07. \n\n^ DiGioia, Anthony M.; Jaramaz, Branislav; Picard, Frederic; Nolte, Lutz-Peter, eds. (30 December 2004). Computer and robotic assisted hip and knee surgery. Oxford University Press. pp. 127\u2013156. ISBN 0-19-850943-X. \n\n^ a b Shweikeh, Faris; Amadio, Jordan P.; Arnell, Monica; Barnard, Zachary R.; Kim, Terrence T.; Johnson, J. Patrick; Drazin, Doniel (2014-03-01). \"Robotics and the spine: a review of current and ongoing applications\". Neurosurgical Focus. 36 (3): E10. doi:10.3171\/2014.1.focus13526. PMID 24580002. \n\n^ Lee, DI (April 2009). \"Robotic prostatectomy: what we have learned and where we are going\". Yonsei Med J. 50 (2): 177\u201381. doi:10.3349\/ymj.2009.50.2.177. PMC 2678689 . PMID 19430547. \n\n^ Williams, SB; Prado, K; Hu, JC (November 2014). \"Economics of robotic surgery: does it make sense and for whom?\". The Urologic clinics of North America. 41 (4): 591\u20136. doi:10.1016\/j.ucl.2014.07.013. PMID 25306170. \n\n^ Ramsay, C; Pickard, R; Robertson, C; Close, A; Vale, L; Armstrong, N; Barocas, DA; Eden, CG; Fraser, C; Gurung, T; Jenkinson, D; Jia, X; Lam, TB; Mowatt, G; Neal, DE; Robinson, MC; Royle, J; Rushton, SP; Sharma, P; Shirley, MD; Soomro, N (2012). \"Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer\". Health technology assessment (Winchester, England). 16 (41): 1\u2013313. doi:10.3310\/hta16410. PMC 4780976 . PMID 23127367. \n\n^ Toesca, Antonio; Peradze, Nickolas; Galimberti, Viviana; Manconi, Andrea; Intra, Mattia; Gentilini, Oreste; Sances, Daniele; Negri, Debora; Veronesi, Giulia (August 2017). \"Robotic Nipple-sparing Mastectomy and Immediate Breast Reconstruction With Implant: First Report of Surgical Technique\". Annals of Surgery. 266 (2): e28\u2013e30. doi:10.1097\/SLA.0000000000001397. ISSN 1528-1140. PMID 28692558. \n\n^ Sarfati, Benjamin; Honart, Jean-Francois; Leymarie, Nicolas; Rimareix, Francoise; Al Khashnam, Heba; Kolb, Frederic (2017-12-18). \"Robotic da Vinci Xi-assisted nipple-sparing mastectomy: First clinical report\". The Breast Journal. doi:10.1111\/tbj.12937. ISSN 1524-4741. PMID 29251382. \n\n^ city, joe torres, eyewitness news, wabc-tv, channel 7, abc 7, 7online, new york (2018-03-06). \"LI doctors perform 1st robotic mastectomy, breast reconstruction in US\". ABC7 New York. Retrieved 2018-04-14 . \n\n^ \"Double Mastectomy And Breast Reconstruction Performed Using A Robot\". 2018-03-06. Retrieved 2018-04-14 . \n\n^ \"Medical Post 23:1985\" (PDF) . \n\n^ Kwoh, Y. S.; Hou, J.; Jonckheere, E. A. & Hayall, S. (February 1988). \"A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery\". IEEE Transactions on Biomedical Engineering. 35 (2): 153\u2013161. doi:10.1109\/10.1354. \n\n^ Lanfranco, Anthony R.; Castellanos, Andres E.; Desai, Jaydev P.; Meyers, William C. (2004). \"Robotic Surgery\". Annals of Surgery. 239 (1): 14\u201321. doi:10.1097\/01.sla.0000103020.19595.7d. PMC 1356187 . PMID 14685095. \n\n^ \"ROBODOC: Surgical Robot Success Story\" (PDF) . Retrieved 25 June 2013 . \n\n^ Meadows, Michelle. \"Computer-Assisted Surgery: An Update\". FDA Consumer magazine. Food and Drug Administration. Archived from the original on 1 March 2009. \n\n^ McConnell, PI; Schneeberger, EW; Michler, RE (2003). \"History and development of robotic cardiac surgery\". Problems in General Surgery. 20 (2): 20\u201330. doi:10.1097\/01.sgs.0000081182.03671.6e. \n\n^ Leslie Versweyveld (29 September 1999). \"ZEUS robot system reverses sterilization to enable birth of baby boy\". Virtual Medical Worlds Monthly. \n\n^ \"Robotics: the Future of Minimally Invasive Heart Surgery\". Biomed.brown.edu. 6 October 1999. Retrieved 29 November 2011 . \n\n^ \"Linbergh Operation \u2013 IRCAD\/EITS Laparoscopic Center\". Retrieved 19 January 2011 . \n\n^ \"Telerobotic Surgery\". SRI International. Retrieved 30 September 2013 . \n\n^ \"New Robot Technology Eases Kidney Transplants\". CBS News. 22 June 2009. Retrieved 8 July 2009 . \n\n^ \"da Vinci Si Surgical System\". Intuitive Surgical. Retrieved 30 September 2013 . \n\n^ \"Autonomous Robotic Surgeon performs surgery on first live human\". Engadget. 19 May 2006. \n\n^ \"Robot surgeon carries out 9-hour operation by itself\". Phys.Org. \n\n^ Parekattil, Sijo. \"Robotic Infertility\". Retrieved 11 October 2012 . \n\n^ \"Surgeons perform world's first pediatric robotic bladder reconstruction\". Esciencenews.com. 20 November 2008. Retrieved 29 November 2011 . \n\n^ \"neuroArm : revolutionary procedure a world first\". ucalgary.ca. 16 May 2008. Retrieved 14 November 2012 . \n\n^ Hagn, U.; Nickl, M.; J\u00f6rg, S.; Tobergte, A.; K\u00fcbler, B.; Passig, G.; Gr\u00f6ger, M.; Fr\u00f6hlich, F.; Seibold, U.; Konietschke, R.; Le-Tien, L.; Albu-Sch\u00e4ffer, A.; Grebenstein, M.; Ortmaier, T. & Hirzinger, G. (2008). \"DLR MiroSurge \u2013 towards versatility in surgical robotics\". Jahrestagung der Deutschen Gesellschaft f\u00fcr Computer und Roboterassistierte Chirurgie; Proceedings of CURAC. 7: 143\u2013146. \n\n^ \"Beter opereren met nieuwe Nederlandse operatierobot Sofie\" (in Dutch). TU\/e. 27 September 2010. Archived from the original on 24 July 2011. Retrieved 10 October 2010 . \n\n^ \"V UKC Ljubljana prvi\u010d na svetu uporabili \u017eilnega robota za posege na femoralnem \u017eilju\" [The First Use of a Vascular Robot for Procedures on Femoral Vasculature] (in Slovenian). 8 November 2010. Retrieved 1 April 2011 . \n\n^ \"UKC Ljubljana kljub finan\u010dnim omejitvam uspe\u0161en v razvoju medicine\" [UMC Ljubljana Successfully Develops Medicine Despite Financial Limitations] (in Slovenian). 30 March 2011. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Surgical robots.\nvteEmerging technologiesFieldsAgriculture\nAgricultural robot\nClosed ecological systems\nCultured meat\nGenetically modified food\nPrecision agriculture\nVertical farming\nArchitecture\nArcology\nBuilding printing\nContour crafting\nDomed city\nBiomedical\nArtificial uterus\nAmpakine\nBrain transplant\nCryonics\nCryoprotectant\nCryopreservation\nVitrification\nSuspended animation\nDe-extinction\nGenetic engineering\nGene therapy\nHead transplant\nIsolated brain\nLife extension\nStrategies for Engineered Negligible Senescence\nNanomedicine\nNanosensors\nOrgan printing\nPersonalized medicine\nRegenerative medicine\nStem-cell therapy\nTissue engineering\nRobot-assisted surgery\nSynthetic 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 16 August 2016, at 17:50.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,350 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","7be8ae6a8cc61a682af74f5c8f893873_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Robot-assisted_surgery skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Robot-assisted surgery<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p class=\"mw-empty-elt\">\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laproscopic_Surgery_Robot.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Laproscopic_Surgery_Robot.jpg\/220px-Laproscopic_Surgery_Robot.jpg\" width=\"220\" height=\"320\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laproscopic_Surgery_Robot.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A robotically assisted surgical system used for prostatectomies, cardiac valve repair and gynecologic surgical procedures<\/div><\/div><\/div>\n<p><b>Robotic surgery<\/b>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-assisted_surgery\" title=\"Computer-assisted surgery\" rel=\"external_link\" target=\"_blank\">computer-assisted surgery<\/a>, and robotically-assisted surgery are terms for technological developments that use robotic systems to aid in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgical procedures<\/a>. Robotically-assisted surgery was developed to overcome the limitations of pre-existing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally-invasive_procedures\" class=\"mw-redirect\" title=\"Minimally-invasive procedures\" rel=\"external_link\" target=\"_blank\">minimally-invasive surgical procedures<\/a> and to enhance the capabilities of surgeons performing open surgery.\n<\/p><p>In the case of robotically-assisted minimally-invasive surgery, instead of directly moving the instruments, the surgeon uses one of two methods to control the instruments; either a direct <a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_manipulator\" title=\"Remote manipulator\" rel=\"external_link\" target=\"_blank\">telemanipulator<\/a> or through computer control. A telemanipulator is a remote manipulator that allows the surgeon to perform the normal movements associated with the surgery whilst the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_arm\" title=\"Robotic arm\" rel=\"external_link\" target=\"_blank\">robotic arms<\/a> carry out those movements using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robot_end_effector\" title=\"Robot end effector\" rel=\"external_link\" target=\"_blank\">end-effectors<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manipulator_(device)\" title=\"Manipulator (device)\" rel=\"external_link\" target=\"_blank\">manipulators<\/a> to perform the actual surgery on the patient. In computer-controlled systems the surgeon uses a computer to control the robotic arms and its end-effectors, though these systems can also still use telemanipulators for their input. One advantage of using the computerised method is that the surgeon does not have to be present, but can be anywhere in the world, leading to the possibility for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_surgery\" title=\"Remote surgery\" rel=\"external_link\" target=\"_blank\">remote surgery<\/a>.\n<\/p><p>In the case of enhanced open surgery, autonomous instruments (in familiar configurations) replace traditional steel tools, performing certain actions (such as rib spreading) with much smoother, feedback-controlled motions than could be achieved by a human hand. The main object of such smart instruments is to reduce or eliminate the tissue trauma traditionally associated with open surgery without requiring more than a few minutes' training on the part of surgeons. This approach seeks to improve open surgeries, particularly cardio-thoracic, that have so far not benefited from minimally-invasive techniques.\n<\/p><p>Robotic surgery has been criticized for its expense, by one estimate costing $1,500 to $2000 more per patient.<sup id=\"rdp-ebb-cite_ref-kolata_1-0\" class=\"reference\"><a href=\"#cite_note-kolata-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Comparison_to_traditional_methods\">Comparison to traditional methods<\/span><\/h2>\n<p>Major advances aided by surgical robots have been <a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_surgery\" title=\"Remote surgery\" rel=\"external_link\" target=\"_blank\">remote surgery<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive_surgery\" class=\"mw-redirect\" title=\"Minimally invasive surgery\" rel=\"external_link\" target=\"_blank\">minimally invasive surgery<\/a> and unmanned surgery. Due to robotic use, the surgery is done with precision, miniaturization, smaller incisions; decreased blood loss, less pain, and quicker healing time. Articulation beyond normal manipulation and three-dimensional magnification helps resulting in improved ergonomics. Due to these techniques there is a reduced duration of hospital stays, blood loss, transfusions, and use of pain medication.<sup id=\"rdp-ebb-cite_ref-Estey_2-0\" class=\"reference\"><a href=\"#cite_note-Estey-2\" rel=\"external_link\">[2]<\/a><\/sup>\nThe existing open surgery technique has many flaws like limited access to surgical area, long recovery time, long hours of operation, blood loss, surgical scars and marks.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>The robot normally costs $1,390,000 and while its disposable supply cost is normally $1,500 per procedure, the cost of the procedure is higher.<sup id=\"rdp-ebb-cite_ref-kolata_1-1\" class=\"reference\"><a href=\"#cite_note-kolata-1\" rel=\"external_link\">[1]<\/a><\/sup> Additional surgical training is needed to operate the system.<sup id=\"rdp-ebb-cite_ref-ORPvsRALRP_4-0\" class=\"reference\"><a href=\"#cite_note-ORPvsRALRP-4\" rel=\"external_link\">[4]<\/a><\/sup> Numerous feasibility studies have been done to determine whether the purchase of such systems are worthwhile. As it stands, opinions differ dramatically. Surgeons report that, although the manufacturers of such systems provide training on this new technology, the learning phase is intensive and surgeons must operate on twelve to eighteen patients before they adapt. During the training phase, minimally invasive operations can take up to twice as long as traditional surgery, leading to operating room tie ups and surgical staffs keeping patients under anesthesia for longer periods. Patient surveys indicate they chose the procedure based on expectations of decreased morbidity, improved outcomes, reduced blood loss and less pain.<sup id=\"rdp-ebb-cite_ref-Estey_2-1\" class=\"reference\"><a href=\"#cite_note-Estey-2\" rel=\"external_link\">[2]<\/a><\/sup> Higher expectations may explain higher rates of dissatisfaction and regret.<sup id=\"rdp-ebb-cite_ref-ORPvsRALRP_4-1\" class=\"reference\"><a href=\"#cite_note-ORPvsRALRP-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not tire as quickly. Naturally occurring hand tremors are filtered out by the robot's computer software. Finally, the surgical robot can continuously be used by rotating surgery teams.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>Critics of the system, including the American Congress of Obstetricians and Gynecologists,<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> say there is a steep learning curve for surgeons who adopt use of the system and that there's a lack of studies that indicate long-term results are superior to results following traditional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic_surgery\" class=\"mw-redirect\" title=\"Laparoscopic surgery\" rel=\"external_link\" target=\"_blank\">laparoscopic surgery<\/a>.<sup id=\"rdp-ebb-cite_ref-kolata_1-2\" class=\"reference\"><a href=\"#cite_note-kolata-1\" rel=\"external_link\">[1]<\/a><\/sup> Articles in the newly created <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Journal_of_Robotic_Surgery\" title=\"Journal of Robotic Surgery\" rel=\"external_link\" target=\"_blank\">Journal of Robotic Surgery<\/a><\/i> tend to report on one surgeon's experience.<sup id=\"rdp-ebb-cite_ref-kolata_1-3\" class=\"reference\"><a href=\"#cite_note-kolata-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>A Medicare study found that some procedures that have traditionally been performed with large incisions can be converted to \"minimally invasive\" endoscopic procedures with the use of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Da_Vinci_Surgical_System\" title=\"Da Vinci Surgical System\" rel=\"external_link\" target=\"_blank\">Da Vinci Surgical System<\/a>, shortening length-of-stay in the hospital and reducing recovery times. But because of the hefty cost of the robotic system it is not clear that it is cost-effective for hospitals and physicians despite any benefits to patients since there is no additional reimbursement paid by the government or insurance companies when the system is used.<sup id=\"rdp-ebb-cite_ref-kolata_1-4\" class=\"reference\"><a href=\"#cite_note-kolata-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Robot-assisted <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pancreatectomy\" title=\"Pancreatectomy\" rel=\"external_link\" target=\"_blank\">pancreatectomies<\/a> have been found to be associated with \"longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay[s]\" than laparoscopic pancreatectomies; there was \"no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups.\"<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> For surgical removal of the uterus and cervix for early <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervical_cancer\" title=\"Cervical cancer\" rel=\"external_link\" target=\"_blank\">cervical cancer<\/a> robotic and laparoscopic surgery resulted in similar outcomes with respect to the cancer.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Uses\">Uses<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Cardiology_and_electrophysiology\">Cardiology and electrophysiology<\/span><\/h3>\n<p>As of 2004, three types of heart surgery are being performed on a routine basis using robotic surgery systems.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> These three surgery types were:\n<\/p>\n<ul><li>Atrial septal defect repair \u2013 the repair of a hole between the two upper chambers of the heart,<\/li>\n<li>Mitral valve repair \u2013 the repair of the valve that prevents blood from regurgitating back into the upper heart chambers during contractions of the heart,<\/li>\n<li>Coronary artery bypass \u2013 rerouting of blood supply by bypassing blocked arteries that provide blood to the heart.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Colon_and_rectal_surgery\">Colon and rectal surgery<\/span><\/h3>\n<p>Many studies have been undertaken in order to examine the role of robotic procedures in the field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colorectal_surgery\" title=\"Colorectal surgery\" rel=\"external_link\" target=\"_blank\">colorectal surgery<\/a>.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>Results to date indicate that robotic-assisted colorectal procedures outcomes are \"no worse\" than the results in the now \"traditional\" laparoscopic colorectal operations. Robotic-assisted colorectal surgery appears to be safe as well.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> Most of the procedures have been performed for malignant colon and rectal lesions. However, surgeons are now moving into resections for diverticulitis and non-resective rectopexies (attaching the colon to the sacrum in order to treat rectal prolapse.)\n<\/p><p>When evaluated for several variables, robotic-assisted procedures fare equally well when compared with laparoscopic, or open abdominal operations. Study parameters have looked at intraoperative patient preparation time, length of time to perform the operation, adequacy of the removed surgical specimen with respect to clear surgical margins and number of lymph nodes removed, blood loss, operative or postoperative complications and long-term results.\n<\/p><p>More difficult to evaluate are issues related to the view of the operative field, the types of procedures that should be performed using robotic assistance and the potential added cost for a robotic operation.\n<\/p><p>Many surgeons feel that the optics of the 3-dimensional, two camera stereo optic robotic system are superior to the optical system used in laparoscopic procedures. The pelvic nerves are clearly visualized during robotic-assisted procedures. Less clear however is whether or not these supposedly improved optics and visualization improve patient outcomes with respect to postoperative impotence or incontinence, and whether long-term patient survival is improved by using the 3-dimensional optic system. Additionally, there is often a need for a wider, or \"larger\" view of the operative field than is routinely provided during robotic operations.,<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> The close-up view of the area under dissection may hamper visualization of the \"bigger view\", especially with respect to ureteral protection.\n<\/p><p>Questions remain unanswered, even after many years of experience with robotic-assisted colorectal operations. Ongoing studies may help clarify many of the issues of confusion associated with this novel surgical approach.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Gastrointestinal_surgery\">Gastrointestinal surgery<\/span><\/h3>\n<p>Multiple types of procedures have been performed with either the 'Zeus' or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Da_Vinci_Surgical_System\" title=\"Da Vinci Surgical System\" rel=\"external_link\" target=\"_blank\">da Vinci<\/a> robot systems, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bariatric_surgery\" title=\"Bariatric surgery\" rel=\"external_link\" target=\"_blank\">bariatric surgery<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastrectomy\" title=\"Gastrectomy\" rel=\"external_link\" target=\"_blank\">gastrectomy<\/a><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> for cancer. Surgeons at various universities initially published case series demonstrating different techniques and the feasibility of GI surgery using the robotic devices.<sup id=\"rdp-ebb-cite_ref-Talamini_M_1524_15-0\" class=\"reference\"><a href=\"#cite_note-Talamini_M_1524-15\" rel=\"external_link\">[15]<\/a><\/sup> Specific procedures have been more fully evaluated, specifically esophageal fundoplication for the treatment of gastroesophageal reflux<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> and Heller myotomy for the treatment of achalasia.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p><p>Other gastrointestinal procedures including colon resection, pancreatectomy, esophagectomy and robotic approaches to pelvic disease have also been reported.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Gynecology\">Gynecology<\/span><\/h3>\n<p>Robotic surgery in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gynecology\" class=\"mw-redirect\" title=\"Gynecology\" rel=\"external_link\" target=\"_blank\">gynecology<\/a> is of uncertain benefit with it being unclear if it affects rates of complications. Gynecologic procedures may take longer with robot-assisted surgery but may be associated with a shorter hospital stay following hysterectomy.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> In the United States, robotic-assisted hysterectomy for benign conditions has been shown to be more expensive than conventional laparoscopic hysterectomy, with no difference in overall rates of complications.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>This includes the use of the da Vinci surgical system in benign gynecology and gynecologic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oncology\" title=\"Oncology\" rel=\"external_link\" target=\"_blank\">oncology<\/a>. Robotic surgery can be used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibroma\" title=\"Fibroma\" rel=\"external_link\" target=\"_blank\">fibroids<\/a>, abnormal periods, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endometriosis\" title=\"Endometriosis\" rel=\"external_link\" target=\"_blank\">endometriosis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ovarian_tumor\" title=\"Ovarian tumor\" rel=\"external_link\" target=\"_blank\">ovarian tumors<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uterine_prolapse\" title=\"Uterine prolapse\" rel=\"external_link\" target=\"_blank\">uterine prolapse<\/a>, and female cancers. Using the robotic system, gynecologists can perform hysterectomies, myomectomies, and lymph node biopsies.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Orthopedics\">Orthopedics<\/span><\/h3>\n<p>Robots are used in orthopedic surgery.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Children\">Children<\/span><\/h3>\n<p>Surgical robotics has been used in many types of pediatric surgical procedures including: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tracheoesophageal_fistula\" title=\"Tracheoesophageal fistula\" rel=\"external_link\" target=\"_blank\">tracheoesophageal fistula<\/a> repair, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholecystectomy\" title=\"Cholecystectomy\" rel=\"external_link\" target=\"_blank\">cholecystectomy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nissen_fundoplication\" title=\"Nissen fundoplication\" rel=\"external_link\" target=\"_blank\">nissen fundoplication<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Morgagni%27s_hernia\" class=\"mw-redirect\" title=\"Morgagni's hernia\" rel=\"external_link\" target=\"_blank\">morgagni's hernia<\/a> repair, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kasai_portoenterostomy\" class=\"mw-redirect\" title=\"Kasai portoenterostomy\" rel=\"external_link\" target=\"_blank\">kasai portoenterostomy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital_diaphragmatic_hernia\" title=\"Congenital diaphragmatic hernia\" rel=\"external_link\" target=\"_blank\">congenital diaphragmatic hernia<\/a> repair, and others.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Spine_surgery\">Spine surgery<\/span><\/h3>\n<p>Robotic devices started to be used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_Invasive_Spine_Surgery\" class=\"mw-redirect\" title=\"Minimally Invasive Spine Surgery\" rel=\"external_link\" target=\"_blank\">minimally invasive spine surgery<\/a> starting in the mid-2000s.<sup id=\"rdp-ebb-cite_ref-Shweikeh2014rev_22-0\" class=\"reference\"><a href=\"#cite_note-Shweikeh2014rev-22\" rel=\"external_link\">[22]<\/a><\/sup> As of 2014, there were too few randomized clinical trials to allow judgements as to whether robotic spine surgery is more or less safe than other approaches.<sup id=\"rdp-ebb-cite_ref-Shweikeh2014rev_22-1\" class=\"reference\"><a href=\"#cite_note-Shweikeh2014rev-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Transplant_surgery\">Transplant surgery<\/span><\/h3>\n<p>Transplant surgery (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Organ_transplantation\" title=\"Organ transplantation\" rel=\"external_link\" target=\"_blank\">organ transplantation<\/a>) has been considered as highly technically demanding and virtually unobtainable by means of conventional laparoscopy. For many years, transplant patients were unable to benefit from the advantages of minimally invasive surgery. The development of robotic technology and its associated high resolution capabilities, three dimensional visual system, wrist type motion and fine instruments, gave opportunity for highly complex procedures to be completed in a minimally invasive fashion. Subsequently, the first fully robotic kidney transplantations were performed in the late 2000s. After the procedure was proven to be feasible and safe, the main emerging challenge was to determine which patients would benefit most from this robotic technique. As a result, recognition of the increasing prevalence of obesity amongst patients with kidney failure on hemodialysis posed a significant problem. Due to the abundantly higher risk of complications after traditional open kidney transplantation, obese patients were frequently denied access to transplantation, which is the premium treatment for end stage kidney disease.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Urology\">Urology<\/span><\/h3>\n<p>Robotic surgery in the field of urology has become very popular, especially in the United States.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> It has been most extensively applied for excision of prostate cancer because of difficult anatomical access. It is also utilized for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney\" title=\"Kidney\" rel=\"external_link\" target=\"_blank\">kidney<\/a> cancer surgeries and to lesser extent surgeries of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bladder\" class=\"mw-redirect\" title=\"Bladder\" rel=\"external_link\" target=\"_blank\">bladder<\/a>.\n<\/p><p>As of 2014, there is little evidence of increased benefits compared to standard surgery to justify the increased costs.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> Some have found tentative evidence of more complete removal of cancer and less side effects from surgery for prostatectomy.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p><p>In 2000, the first robot-assisted laparoscopic radical prostatectomy was performed.<sup id=\"rdp-ebb-cite_ref-ORPvsRALRP_4-2\" class=\"reference\"><a href=\"#cite_note-ORPvsRALRP-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p><b>Breast Surgery<\/b>\n<\/p><p>Robotic breast surgery involves using the robot to assist in performing nipple-sparing mastectomy and breast reconstruction. In 2015, a group of surgeons led by Dr. Antonio Toesca, in Milan, Italy demonstrated the feasibility and safety of robotic nipple-sparing mastectomy and robotic breast reconstruction.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> The Italian surgeons published their results in their first 29 consecutive patients. In this report, all patients had robotic mastectomy and reconstruction done through a 3 cm extra-mammary incision, hidden by the arm. Thereafter, a surgeon, Dr. Benjamin Sarfati, in Paris began performing robotic mastectomy and breast reconstruction.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> On March 4, 2018, Dr. Neil Tanna and colleagues performed the first robotic nipple-sparing mastectomy and robotic breast reconstruction in North America.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup><b> <\/b>\n<\/p><p>Traditional (open) nipple-sparing mastectomy and breast reconstruction require incisions on the breast. Robotic nipple sparing mastectomy with robotic breast reconstruction is an innovative form of breast surgery that utilizes robotic technology to perform the surgery. By using the robot, the incisions can be much smaller and be placed off the breasts, far away near the armpit or the bra line.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The first robot to assist in surgery was the <i>Arthrobot<\/i>, which was developed and used for the first time in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vancouver\" title=\"Vancouver\" rel=\"external_link\" target=\"_blank\">Vancouver<\/a> in 1983.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> Intimately involved were <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biomedical_engineering\" title=\"Biomedical engineering\" rel=\"external_link\" target=\"_blank\">biomedical engineer<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/James_McEwen_(engineer)\" title=\"James McEwen (engineer)\" rel=\"external_link\" target=\"_blank\">Dr. James McEwen<\/a>, Geof Auchinleck, a UBC <a href=\"https:\/\/en.wikipedia.org\/wiki\/Engineering_physics\" title=\"Engineering physics\" rel=\"external_link\" target=\"_blank\">engineering physics<\/a> grad, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brian_Day\" title=\"Brian Day\" rel=\"external_link\" target=\"_blank\">Dr. Brian Day<\/a> as well as a team of engineering students. The robot was used in an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopaedy\" class=\"mw-redirect\" title=\"Orthopaedy\" rel=\"external_link\" target=\"_blank\">orthopaedic<\/a> surgical procedure on 12 March 1984, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/UBC_Hospital\" title=\"UBC Hospital\" rel=\"external_link\" target=\"_blank\">UBC Hospital<\/a> in Vancouver. Over 60 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroscopy\" title=\"Arthroscopy\" rel=\"external_link\" target=\"_blank\">arthroscopic<\/a> surgical procedures were performed in the first 12 months, and a 1985 <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Geographic_Society\" title=\"National Geographic Society\" rel=\"external_link\" target=\"_blank\">National Geographic<\/a> video on industrial robots, <i>The Robotics Revolution<\/i>, featured the device. Other related robotic devices developed at the same time included a surgical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scrub_nurse\" class=\"mw-redirect\" title=\"Scrub nurse\" rel=\"external_link\" target=\"_blank\">scrub nurse<\/a> robot, which handed operative instruments on voice command, and a medical laboratory robotic arm. A YouTube video entitled <i>Arthrobot<\/i> illustrates some of these in operation.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>In 1985 a robot, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Programmable_Universal_Machine_for_Assembly\" title=\"Programmable Universal Machine for Assembly\" rel=\"external_link\" target=\"_blank\">Unimation Puma 200<\/a>, was used to place a needle for a brain biopsy using CT guidance.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> PROBOT was then used to perform prostatic surgery and ROBODOC to assist with hip replacement surgeries. The latter was the first surgical robot that was approved by the FDA.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> The ROBODOC from Integrated Surgical Systems (working closely with <a href=\"https:\/\/en.wikipedia.org\/wiki\/IBM\" title=\"IBM\" rel=\"external_link\" target=\"_blank\">IBM<\/a>) was introduced in 1992 to mill out precise fittings in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femur\" title=\"Femur\" rel=\"external_link\" target=\"_blank\">femur<\/a> for hip replacement.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup> The purpose of the ROBODOC was to replace the previous method of carving out a femur for an implant, the use of a mallet and broach\/rasp.\n<\/p><p>Further development of robotic systems was carried out by <a href=\"https:\/\/en.wikipedia.org\/wiki\/SRI_International\" title=\"SRI International\" rel=\"external_link\" target=\"_blank\">SRI International<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intuitive_Surgical\" title=\"Intuitive Surgical\" rel=\"external_link\" target=\"_blank\">Intuitive Surgical<\/a> with the introduction of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Da_Vinci_Surgical_System\" title=\"Da Vinci Surgical System\" rel=\"external_link\" target=\"_blank\">da Vinci Surgical System<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer_Motion\" class=\"mw-redirect\" title=\"Computer Motion\" rel=\"external_link\" target=\"_blank\">Computer Motion<\/a> with the <i>AESOP<\/i> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ZEUS_robotic_surgical_system\" title=\"ZEUS robotic surgical system\" rel=\"external_link\" target=\"_blank\">ZEUS robotic surgical system<\/a>.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup> The first robotic surgery took place at <a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Ohio_State_University_Medical_Center\" class=\"mw-redirect\" title=\"The Ohio State University Medical Center\" rel=\"external_link\" target=\"_blank\">The Ohio State University Medical Center<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Columbus,_Ohio\" title=\"Columbus, Ohio\" rel=\"external_link\" target=\"_blank\">Columbus<\/a>, Ohio under the direction of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_E._Michler\" title=\"Robert E. Michler\" rel=\"external_link\" target=\"_blank\">Robert E. Michler<\/a>.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup> Examples of using ZEUS include a fallopian tube reconnection in July 1998,<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup> a <i>beating heart<\/i> coronary artery bypass graft in October 1999,<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lindbergh_Operation\" class=\"mw-redirect\" title=\"Lindbergh Operation\" rel=\"external_link\" target=\"_blank\">Lindbergh Operation<\/a>, which was a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholecystectomy\" title=\"Cholecystectomy\" rel=\"external_link\" target=\"_blank\">cholecystectomy<\/a> performed remotely in September 2001.<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup>\n<\/p><p>The original telesurgery robotic system that the da Vinci was based on was developed at SRI International in Menlo Park with grant support from DARPA and NASA.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup> Although the telesurgical robot was originally intended to facilitate remotely performed surgery in battlefield and other remote environments, it turned out to be more useful for minimally invasive on-site surgery. The patents for the early prototype were sold to Intuitive Surgical in Mountain View, California. The da Vinci senses the surgeon's hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. Examples of using the da Vinci system include the first robotically assisted <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_bypass\" class=\"mw-redirect\" title=\"Heart bypass\" rel=\"external_link\" target=\"_blank\">heart bypass<\/a> (performed in Germany) in May 1998, and the first performed in the United States in September 1999;<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (January 2011)\">citation needed<\/span><\/a><\/i>]<\/sup> and the first all-robotic-assisted <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_transplant\" class=\"mw-redirect\" title=\"Kidney transplant\" rel=\"external_link\" target=\"_blank\">kidney transplant<\/a>, performed in January 2009.<sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup> The da Vinci Si was released in April 2009, and initially sold for $1.75 million.<sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/p><p>In May 2006 the first <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_intelligence\" title=\"Artificial intelligence\" rel=\"external_link\" target=\"_blank\">artificial intelligence<\/a> doctor-conducted unassisted robotic surgery was on a 34-year-old male to correct <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_arrythmia\" class=\"mw-redirect\" title=\"Heart arrythmia\" rel=\"external_link\" target=\"_blank\">heart arrythmia<\/a>. The results were rated as better than an above-average human surgeon. The machine had a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Database\" title=\"Database\" rel=\"external_link\" target=\"_blank\">database<\/a> of 10,000 similar operations, and so, in the words of its designers, was \"more than qualified to operate on any patient\".<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup> In August 2007, Dr. Sijo Parekattil of the Robotics Institute and Center for Urology (Winter Haven Hospital and University of Florida) performed the first robotic assisted microsurgery procedure denervation of the spermatic cord for chronic testicular pain.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup> In February 2008, Dr. Mohan S. Gundeti of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Chicago_Comer_Children%27s_Hospital\" class=\"mw-redirect\" title=\"University of Chicago Comer Children's Hospital\" rel=\"external_link\" target=\"_blank\">University of Chicago Comer Children's Hospital<\/a> performed the first robotic pediatric neurogenic bladder reconstruction.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup>\n<\/p><p>On 12 May 2008, the first image-guided MR-compatible robotic neurosurgical procedure was performed at <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Calgary\" title=\"University of Calgary\" rel=\"external_link\" target=\"_blank\">University of Calgary<\/a> by Dr. Garnette Sutherland using the <a href=\"https:\/\/en.wikipedia.org\/wiki\/NeuroArm\" title=\"NeuroArm\" rel=\"external_link\" target=\"_blank\">NeuroArm<\/a>.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> In June 2008, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/German_Aerospace_Centre\" class=\"mw-redirect\" title=\"German Aerospace Centre\" rel=\"external_link\" target=\"_blank\">German Aerospace Centre<\/a> (DLR) presented a robotic system for minimally invasive surgery, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/MiroSurge\" title=\"MiroSurge\" rel=\"external_link\" target=\"_blank\">MiroSurge<\/a>.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup> In September 2010, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eindhoven_University_of_Technology\" title=\"Eindhoven University of Technology\" rel=\"external_link\" target=\"_blank\">Eindhoven University of Technology<\/a> announced the development of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sofie_(surgical_robot)\" title=\"Sofie (surgical robot)\" rel=\"external_link\" target=\"_blank\">Sofie<\/a> surgical system, the first surgical robot to employ <a href=\"https:\/\/en.wikipedia.org\/wiki\/Force_feedback\" class=\"mw-redirect\" title=\"Force feedback\" rel=\"external_link\" target=\"_blank\">force feedback<\/a>.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup> In September 2010, the first robotic operation at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femoral_vasculature\" class=\"mw-redirect\" title=\"Femoral vasculature\" rel=\"external_link\" target=\"_blank\">femoral vasculature<\/a> was performed at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_Medical_Centre_Ljubljana\" class=\"mw-redirect\" title=\"University Medical Centre Ljubljana\" rel=\"external_link\" target=\"_blank\">University Medical Centre Ljubljana<\/a> by a team led by .<sup id=\"rdp-ebb-cite_ref-FV_robo1_49-0\" class=\"reference\"><a href=\"#cite_note-FV_robo1-49\" rel=\"external_link\">[49]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FV_robo2_50-0\" class=\"reference\"><a href=\"#cite_note-FV_robo2-50\" rel=\"external_link\">[50]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_segment_navigation\" title=\"Bone segment navigation\" rel=\"external_link\" target=\"_blank\">Bone segment navigation<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-assisted_surgery\" title=\"Computer-assisted surgery\" rel=\"external_link\" target=\"_blank\">Computer-assisted surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-integrated_surgery\" class=\"mw-redirect\" title=\"Computer-integrated surgery\" rel=\"external_link\" target=\"_blank\">Computer-integrated surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive_surgery\" class=\"mw-redirect\" title=\"Minimally invasive surgery\" rel=\"external_link\" target=\"_blank\">Minimally invasive surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_registration\" title=\"Patient registration\" rel=\"external_link\" target=\"_blank\">Patient registration<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereolithography_(medicine)\" class=\"mw-redirect\" title=\"Stereolithography (medicine)\" rel=\"external_link\" target=\"_blank\">Stereolithography (medicine)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_Segment_Navigator\" class=\"mw-redirect\" title=\"Surgical Segment Navigator\" rel=\"external_link\" target=\"_blank\">Surgical Segment Navigator<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Telemedicine\" title=\"Telemedicine\" rel=\"external_link\" target=\"_blank\">Telemedicine<\/a><\/li><\/ul><\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-kolata-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-kolata_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-kolata_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-kolata_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-kolata_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-kolata_1-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Kolata, Gina (13 February 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2010\/02\/14\/health\/14robot.html\" target=\"_blank\">\"Results Unproven, Robotic Surgery Wins Converts\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_New_York_Times\" title=\"The New York Times\" rel=\"external_link\" target=\"_blank\">The New York Times<\/a><\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">11 March<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Results+Unproven%2C+Robotic+Surgery+Wins+Converts&rft.date=2010-02-13&rft.aulast=Kolata&rft.aufirst=Gina&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2010%2F02%2F14%2Fhealth%2F14robot.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Estey-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Estey_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Estey_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Estey, EP (2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2792423\" target=\"_blank\">\"Robotic prostatectomy: The new standard of care or a marketing success?\"<\/a>. <i>Canadian Urological Association Journal<\/i>. <b>3<\/b> (6): 488\u201390. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2792423\" target=\"_blank\">2792423<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20019980\" target=\"_blank\">20019980<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Canadian+Urological+Association+Journal&rft.atitle=Robotic+prostatectomy%3A+The+new+standard+of+care+or+a+marketing+success%3F&rft.volume=3&rft.issue=6&rft.pages=488-90&rft.date=2009&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2792423&rft_id=info%3Apmid%2F20019980&rft.aulast=Estey&rft.aufirst=EP&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2792423&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">O'Toole, M. D.; Bouazza-Marouf, K.; Kerr, D.; Gooroochurn, M.; Vloeberghs, M. 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top: -2px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Paywall\" title=\"closed access publication \u2013 behind paywall\" rel=\"external_link\" target=\"_blank\"><img alt=\"closed access publication \u2013 behind paywall\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c1\/Closed_Access_logo_alternative.svg\/9px-Closed_Access_logo_alternative.svg.png\" width=\"9\" height=\"14\" \/><\/a><\/span><\/span>\n<\/li>\n<li id=\"cite_note-ORPvsRALRP-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ORPvsRALRP_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ORPvsRALRP_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ORPvsRALRP_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Finkelstein J; Eckersberger E; Sadri H; Taneja SS; Lepor H; Djavan B (2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2859140\" target=\"_blank\">\"Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US Experience\"<\/a>. <i>Reviews in Urology<\/i>. <b>12<\/b> (1): 35\u201343. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2859140\" target=\"_blank\">2859140<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20428292\" target=\"_blank\">20428292<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Reviews+in+Urology&rft.atitle=Open+Versus+Laparoscopic+Versus+Robot-Assisted+Laparoscopic+Prostatectomy%3A+The+European+and+US+Experience&rft.volume=12&rft.issue=1&rft.pages=35-43&rft.date=2010&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2859140&rft_id=info%3Apmid%2F20428292&rft.au=Finkelstein+J&rft.au=Eckersberger+E&rft.au=Sadri+H&rft.au=Taneja+SS&rft.au=Lepor+H&rft.au=Djavan+B&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2859140&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gerhardus, D (July\u2013August 2003). \"Robot-assisted surgery: the future is here\". <i>Journal of Healthcare Management<\/i>. <b>48<\/b> (4): 242\u2013251. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12908224\" target=\"_blank\">12908224<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Healthcare+Management&rft.atitle=Robot-assisted+surgery%3A+the+future+is+here&rft.volume=48&rft.issue=4&rft.pages=242-251&rft.date=2003-07%2F2003-08&rft_id=info%3Apmid%2F12908224&rft.aulast=Gerhardus&rft.aufirst=D&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Breeden, James T., MD, President of ACOG, <a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.acog.org\/About-ACOG\/News-Room\/News-Releases\/2013\/Statement-on-Robotic-Surgery\" target=\"_blank\">[1]<\/a> Statement on Robotic Surgery, 14 March 2013<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zhou, JY; 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TU\/e. 27 September 2010. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/w3.wtb.tue.nl\/nl\/nieuws\/artikel\/?tx_ttnews%5Btt_news%5D=10041&tx_ttnews%5BbackPid%5D=465&cHash=ebb243e7ff\" target=\"_blank\">the original<\/a> on 24 July 2011<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">10 October<\/span> 2010<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Beter+opereren+met+nieuwe+Nederlandse+operatierobot+Sofie&rft.pub=TU%2Fe&rft.date=2010-09-27&rft_id=http%3A%2F%2Fw3.wtb.tue.nl%2Fnl%2Fnieuws%2Fartikel%2F%3Ftx_ttnews%255Btt_news%255D%3D10041%26tx_ttnews%255BbackPid%255D%3D465%26cHash%3Debb243e7ff&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FV_robo1-49\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FV_robo1_49-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/med.over.net\/index.php?full=1&id=25545&title=V_UKC_Ljubljana_prvi___na_svetu_uporabili___ilnega_robota_za_posege_na_femoralnem___ilju\" target=\"_blank\">\"V UKC Ljubljana prvi\u010d na svetu uporabili \u017eilnega robota za posege na femoralnem \u017eilju\"<\/a> [The First Use of a Vascular Robot for Procedures on Femoral Vasculature] (in Slovenian). 8 November 2010<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">1 April<\/span> 2011<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=V+UKC+Ljubljana+prvi%C4%8D+na+svetu+uporabili+%C5%BEilnega+robota+za+posege+na+femoralnem+%C5%BEilju&rft.date=2010-11-08&rft_id=http%3A%2F%2Fmed.over.net%2Findex.php%3Ffull%3D1%26id%3D25545%26title%3DV_UKC_Ljubljana_prvi___na_svetu_uporabili___ilnega_robota_za_posege_na_femoralnem___ilju&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FV_robo2-50\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FV_robo2_50-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.dnevnik.si\/novice\/zdravje\/1042434634\" target=\"_blank\">\"UKC Ljubljana kljub finan\u010dnim omejitvam uspe\u0161en v razvoju medicine\"<\/a> [UMC Ljubljana Successfully Develops Medicine Despite Financial Limitations] (in Slovenian). 30 March 2011.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=UKC+Ljubljana+kljub+finan%C4%8Dnim+omejitvam+uspe%C5%A1en+v+razvoju+medicine&rft.date=2011-03-30&rft_id=http%3A%2F%2Fwww.dnevnik.si%2Fnovice%2Fzdravje%2F1042434634&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1238\nCached time: 20181207063720\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.068 seconds\nReal time usage: 1.219 seconds\nPreprocessor visited node count: 3463\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 200452\/2097152 bytes\nTemplate argument size: 3623\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 10\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 134007\/5000000 bytes\nNumber of Wikibase entities loaded: 6\/400\nLua time usage: 0.627\/10.000 seconds\nLua memory usage: 5.58 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 996.491 1 -total\n<\/p>\n<pre>67.47% 672.299 1 Template:Reflist\n32.46% 323.433 24 Template:Cite_journal\n14.23% 141.787 8 Template:Cite_news\n 9.83% 97.985 12 Template:Cite_web\n 9.60% 95.657 4 Template:Citation_needed\n 8.79% 87.597 4 Template:Fix\n 8.11% 80.861 6 Template:Navbox\n 7.59% 75.681 1 Template:Commons_category\n 5.58% 55.585 1 Template:Emerging_technologies\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2629669-1!canonical and timestamp 20181207063719 and revision id 871820311\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Robot-assisted_surgery\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214706\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.017 seconds\nReal time usage: 0.165 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 155.035 1 - wikipedia:Robot-assisted_surgery\n100.00% 155.035 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8308-0!*!*!*!*!*!* and timestamp 20181217214706 and revision id 27028\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Robot-assisted_surgery\">https:\/\/www.limswiki.org\/index.php\/Robot-assisted_surgery<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","7be8ae6a8cc61a682af74f5c8f893873_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Laproscopic_Surgery_Robot.jpg\/440px-Laproscopic_Surgery_Robot.jpg"],"7be8ae6a8cc61a682af74f5c8f893873_timestamp":1545083226,"030820c81ed47c2bd6404f897e7a000a_type":"article","030820c81ed47c2bd6404f897e7a000a_title":"Remote surgery","030820c81ed47c2bd6404f897e7a000a_url":"https:\/\/www.limswiki.org\/index.php\/Remote_surgery","030820c81ed47c2bd6404f897e7a000a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tRemote surgery\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tRemote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. A robot surgical system generally consists of one or more arms (controlled by the surgeon), a master controller (console), and a sensory system giving feedback to the user.[1][2] Remote surgery combines elements of robotics, cutting edge communication technology such as high-speed data connections and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery. Remote surgery is essentially advanced telecommuting for surgeons, where the physical distance between the surgeon and the patient is less relevant. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.\n\nContents \n\n1 Surgical systems \n2 Costs \n3 The Lindbergh Operation \n4 Technology \n5 Applications \n6 Unassisted robotic surgery \n7 Force-feedback and time delay \n8 Depth perception \n9 Possible uses \n10 Limitations \n11 See also \n12 References \n13 External links \n\n\nSurgical systems \nSurgical robot systems have been developed from the first functional telesurgery system-ZEUS-to the da Vinci Surgical System, which is currently the only commercially available surgical robotic system. In Israel a company was established by Professor Moshe Schoham, from the faculty of Mechanical Engeenering at the Technion. Used mainly for \u201con-site\u201d surgery, these robots assist the surgeon visually, with better precision and less invasiveness to patients.[1][2] The Da Vinci Surgical System has also been combined to form a Dual Da Vinci system which allows two surgeons to work together on a patient at the same time. The system gives the surgeons the ability to control different arms, switch command of arms at any point and communicate through headsets during the operation.[3]\n\nCosts \nMarketed for $975,000, the ZEUS Robot Surgical System was less expensive than the da Vinci Surgical System, which cost $1 million. The cost of an operation through telesurgery is not precise but must pay for the surgical system, the surgeon, and contribute to paying for a year\u2019s worth of ATM technology which runs between $100,000-$200,000.[citation needed ][4]\n\nThe Lindbergh Operation \nMain article: Lindbergh Operation\nThe first true and complete remote surgery was conducted on 7 September 2001 across the Atlantic Ocean, with French surgeon (Dr. Jacques Marescaux) in New York City performing a cholecystectomy on a 68-year-old female patient 6,230 km away in Strasbourg, France. It was named Operation Lindbergh.[5] after Charles Lindbergh\u2019s pioneering transatlantic flight from New York to Paris. France Telecom provided the redundant fiberoptic ATM lines to minimize latency and optimize connectivity, and Computer Motion provided a modified Zeus robotic system. After clinical evaluation of the complete solution in July 2001, the human operation was successfully completed on 9\/7\/2001.[6]\nThe success and exposure of the procedure led the robotic team to use the same technology within Canada, this time using Bell Canada's public internet between Hamilton, Ontario and North Bay, Ontario (a distance of about 400 kilometers). While operation Lindbergh used the most expensive ATM fiber optics communication to ensure reliability and success of the first telesurgery, the follow on procedures in Canada used standard public internet which was provisioned with QOS using MPLS QOS-MPLS. A series of complex laparoscopic procedures were performed where in this case, the expert clinician would support the surgeon who was less experienced, operating on his patient. This resulted in patient receiving the best care possible while remaining in their hometown, the less experienced surgeon gaining valuable experience, and the expert surgeon providing their expertise without travel. The robotic team's goal was to go from Lindbergh's proof of concept to a real-life solution. This was achieved with over 20 complex laparoscopic operations between Hamilton and North Bay.\n\nTechnology \nThe speed of remote surgery is made possible through ATM technology, or Asynchronous Transfer Mode. \u201cAsynchronous Transfer Mode is a technology designed for the high-speed transfer of voice, video, and data through public and private networks using cell relay technology\u201d. Cell relay technology is the method of using small fixed length packets or cells to transfer data between computers or network equipment and determines the speed at which information is transferred. ATM technology has a maximum speed of 10 Gbit\/s (Gigabits per second). This developed technology provides opportunities for more transatlantic surgeries similar to the Operation Lindbergh.[7] During a surgery, the robot arm can use a different angle during a laparoscopic surgery than a tool in the surgeon\u2019s hand, providing easier movement. The da Vinci Surgical System, using \"Endowrist\" instruments, allows the surgeon seven degrees of rotation and a range of motion far greater than the human hand while filtering out the hand\u2019s natural tremor.[2][8]\n\nApplications \nSince Operation Lindbergh, remote surgery has been conducted many times in numerous locations. To date Dr. Anvari, a laparoscopic surgeon in Hamilton, Canada, has conducted numerous remote surgeries on patients in North Bay, a city 400 kilometres from Hamilton.[9] Even though he uses a VPN over a non-dedicated fiberoptic connection that shares bandwidth with regular telecommunications data, Dr. Anvari has not had any connection problems during his procedures.[citation needed ]\nRapid development of technology has allowed remote surgery rooms to become highly specialized. At the Advanced Surgical Technology Centre at Mt. Sinai Hospital in Toronto, Canada, the surgical room responds to the surgeon\u2019s voice commands in order to control a variety of equipment at the surgical site, including the lighting in the operating room, the position of the operating table and the surgical tools themselves. With continuing advances in communication technologies, the availability of greater bandwidth and more powerful computers, the ease and cost effectiveness of deploying remote surgery units is likely to increase rapidly.\nThe possibility of being able to project the knowledge and the physical skill of a surgeon over long distances has many attractions. There is considerable research underway in the subject. The armed forces have an obvious interest since the combination of telepresence, teleoperation, and telerobotics can potentially save the lives of battle casualties by providing them with prompt attention in mobile operating theatres.\nAnother potential advantage of having robots perform surgeries is accuracy. A study conducted at Guy\u2019s Hospital in London, England compared the success of kidney surgeries in 304 dummy patients conducted traditionally as well as remotely and found that those conducted using robots were more successful in accurately targeting kidney stones.[10]\nIn 2015, another test was conducted on the lag time involved in the robotic surgery. A Florida hospital successfully tested lag time created by the Internet for a simulated robotic surgery in Ft. Worth, Texas, more than 1,200 miles away from the surgeon who was at the virtual controls. The team found out that the lag time in robotic surgeries, were insignificant. Roger Smith, CTO at the Florida Hospital Nicholson Center said that the team had concluded that, telesurgery is something that is possible and generally safe for large areas within the United States.[11][12]\n\nUnassisted robotic surgery \nAs the techniques of expert surgeons are studied and stored in special computer systems, robots might one day be able to perform surgeries with little or no human input. Carlo Pappone, an Italian surgeon, has developed a software program that uses data collected from several surgeons and thousands of operations to perform the surgery without human intervention.[13][unreliable source? ] This could one day make expensive, complicated surgeries much more widely available, even to patients in regions which have traditionally lacked proper medical facilities.\n\nForce-feedback and time delay \nThe ability to carry out delicate manipulations relies greatly upon feedback. For example, it is easy to learn how much pressure is required to handle an egg. In robotic surgery, surgeons need to be able to perceive the amount of force being applied without directly touching the surgical tools. Systems known as force-feedback, or haptic technology, have been developed to simulate this. Haptics is the science of touch. Any type of Haptic feedback provides a responsive force in opposition to the touch of the hand. Haptic technology in telesurgery, making a virtual image of a patient or incision, would allow a surgeon to see what they are working on as well as feel it. This technology is designed to give a surgeon the ability to feel tendons and muscles as if it were actually the patient's body.[8][14] However these systems are very sensitive to time-delays such as those present in the networks used in remote surgery.\n\nDepth perception \nBeing able to gauge the depth of an incision is crucial. Humans' binocular vision makes this easy in a three-dimensional environment. However this can be much more difficult when the view is presented on a flat computer screen.\n\nPossible uses \nOne possible use of remote surgery is the Trauma-Pod project conceived by the US military under the Defense Advanced Research Agency. This system is intended to aid wounded soldiers in the battlefield by making use of the skills of remotely located medical personnel.\nAnother future possibility could be the use of remote surgery during long space exploration missions.\n\nLimitations \nFor now, remote surgery is not a widespread technology in part because it does not have sponsorship by the governments.[15] Before its acceptance on a broader scale, many issues will need to be resolved. For example, established clinical protocols, training, and global compatibility of equipment must be developed. Also, there is still the need for an anesthesiologist and a backup surgeon to be present in case there is a disruption of communications or a malfunction in the robot. Nevertheless, Operation Lindbergh proved that the technology exists today to enable delivery of expert care to remote areas of the globe.\n\nSee also \nWaldo (short story) by Robert A. Heinlein.\nReferences \n\n^ a b Sandor, Jozsef; Haidegger, Tamas; Benyo, Zoltan (2012). \"Surgery in Space: The Future of Robotic Telesurgery\". Surgical Endoscopy. 26 (1): 681\u2013690. \n\n^ a b c Intuitive Surgical. 2012. \"The Da Vinci Surgical System.\" Intuitive Surgical. http:\/\/www.intuitivesurgical.com\/products\/davinci_surgical_system\/. \n\n^ Hanly, Miller; Kumar, Coste-Maniere; Talamini, Aurora; Schenkman (2006). \"Mentoring Console Improves\". J Laparoendosc Adv Surg Tech A. 5: 445\u2013451. \n\n^ Morris, B (2005). \"Robotic surgery: applications, limitations, and impact on surgical education\". MedGenMed. 7: 72. PMC 1681689 . PMID 16369298. \n\n^ http:\/\/www.intersurgtech.com\/media.html \n\n^ Event videos: http:\/\/www.intersurgtech.com\/media.html \n\n^ Cisco. 1992. \"Guide to ATM Technology - ATM Technology Fundamentals [Cisco Catalyst 8500 Series Multiservice Switch Routers] - Cisco Systems.\" http:\/\/www.cisco.com\/en\/US\/products\/hw\/switches\/ps718\/products_technical_reference_chapter09186a00800eb6fb.html#wp1019851. Archived 28 April 2012 at the Wayback Machine. \n\n^ a b Murphy, Challacombe; Khan; Dasgupta (2006). \"Robotic Technology in Urology\". Postgraduate Medical Journal. 82 (973): 743\u2013747. doi:10.1136\/pgmj.2006.048140. PMC 2660512 . \n\n^ \"Dr. Mehran Anvari\". Centre for Surgical Invention & Innovation. Retrieved 19 August 2016 . \n\n^ Revill, Jo (5 October 2002). \"' Remote' surgery turning point\". The Guardian. \n\n^ \"Hospital Tests Lag Time for Remote Surgery 12,000 Miles Away\". Raw Science. 2015-07-15. Retrieved 2017-09-20 . \n\n^ Mearian, Lucas. \"Hospital tests lag time for robotic surgery 1,200 miles away from doctor\". Computerworld. Retrieved 2017-09-20 . \n\n^ Robot Successfully Completes Unassisted Heart Surgery Digital Lifestyle Magazine @ dlmag.com \n\n^ Immersion Corporation. 2012. \"Haptic Technology\". \n\n^ Rosen, Jacob, Blake Hannaford, and Richard M. Satava. 2010. Surgical Robotics: Systems Applications and Visions. Springer. \n\n\nExternal links \n\n\n\nLook up telesurgery in Wiktionary, the free dictionary.\nArticle and Media Gallery for telesurgery\nPBS article on telesurgery\nUsing remote surgery as a teaching tool\nHow robotic surgery works\nArticle in Pulse of the Planet about remote surgery\nBBC News SCI\/TECH -- First transatlantic surgery\nHigh Performance Network Video in support of Telesurgery \/ NEEMO7 Mission - Revolutionary Telemedicine Techniques\nRobot Successfully Completes Unassisted Heart Surgery\nvteTelemedicineBackground concepts\nHealth informatics\nIn absentia health care\nTelecommunication\nMedical record\nAdmission note\nBlue Button\nDe-identification\nElectronic health record\nHealth Insurance Portability and Accountability Act\nPersonal health record\nPatient participation\nDecision aids\nDoctor\u2013patient relationship\nE-patient\nHealth 2.0\nHealth education\nKnowledge translation\nmHealth\nParticipative decision-making\nPatient Activation Measure\nShared decision-making\nHealth information on the Internet\nHealth information on Wikipedia\nOnline patient education\nPubMed\nTelemedicine subspecialties\neHealth\nRemote surgery\nRemote therapy\nTele-audiology\nTele-epidemiology\nTeledentistry\nTeledermatology\nTelehealth\nTelemental health\nTelenursing\nTeleophthalmology\nTelepathology\nTelepharmacy\nTelepsychiatry\nTeleradiology\nTelerehabilitation\nRoles to play\nOpen-source healthcare software\nPatient opinion leader\nResearch participant\nVirtual patient\n\n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Remote_surgery\">https:\/\/www.limswiki.org\/index.php\/Remote_surgery<\/a>\n\t\t\t\t\tCategories: Computer-assisted surgeryHealth informaticsMedical and surgical techniquesMedical roboticsHidden category: Articles 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","030820c81ed47c2bd6404f897e7a000a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Remote_surgery skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Remote surgery<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Remote surgery<\/b> (also known as <b>telesurgery<\/b>) is the ability for a doctor to perform <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a> on a patient even though they are not physically in the same location. It is a form of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telepresence\" title=\"Telepresence\" rel=\"external_link\" target=\"_blank\">telepresence<\/a>. A robot surgical system generally consists of one or more arms (controlled by the surgeon), a master controller (console), and a sensory system giving feedback to the user.<sup id=\"rdp-ebb-cite_ref-sandor_1-0\" class=\"reference\"><a href=\"#cite_note-sandor-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-intuitivesurgical.com_2-0\" class=\"reference\"><a href=\"#cite_note-intuitivesurgical.com-2\" rel=\"external_link\">[2]<\/a><\/sup> Remote surgery combines elements of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robot\" title=\"Robot\" rel=\"external_link\" target=\"_blank\">robotics<\/a>, cutting edge <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telecommunication\" title=\"Telecommunication\" rel=\"external_link\" target=\"_blank\">communication technology<\/a> such as high-speed data connections and elements of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Management_information_system\" title=\"Management information system\" rel=\"external_link\" target=\"_blank\">management information systems<\/a>. While the field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">robotic surgery<\/a> is fairly well established, most of these robots are controlled by surgeons at the location of the surgery. Remote surgery is essentially advanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telecommuting\" title=\"Telecommuting\" rel=\"external_link\" target=\"_blank\">telecommuting<\/a> for surgeons, where the physical distance between the surgeon and the patient is less relevant. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Surgical_systems\">Surgical systems<\/span><\/h2>\n<p>Surgical robot systems have been developed from the first functional telesurgery system-ZEUS-to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Da_Vinci_Surgical_System\" title=\"Da Vinci Surgical System\" rel=\"external_link\" target=\"_blank\">da Vinci Surgical System<\/a>, which is currently the only commercially available surgical robotic system. In Israel a company was established by Professor Moshe Schoham, from the faculty of Mechanical Engeenering at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Technion\" class=\"mw-redirect\" title=\"Technion\" rel=\"external_link\" target=\"_blank\">Technion<\/a>. Used mainly for \u201con-site\u201d surgery, these robots assist the surgeon visually, with better precision and less invasiveness to patients.<sup id=\"rdp-ebb-cite_ref-sandor_1-1\" class=\"reference\"><a href=\"#cite_note-sandor-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-intuitivesurgical.com_2-1\" class=\"reference\"><a href=\"#cite_note-intuitivesurgical.com-2\" rel=\"external_link\">[2]<\/a><\/sup> The Da Vinci Surgical System has also been combined to form a Dual Da Vinci system which allows two surgeons to work together on a patient at the same time. The system gives the surgeons the ability to control different arms, switch command of arms at any point and communicate through headsets during the operation.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Costs\">Costs<\/span><\/h2>\n<p>Marketed for $975,000, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ZEUS_robotic_surgical_system\" title=\"ZEUS robotic surgical system\" rel=\"external_link\" target=\"_blank\">ZEUS Robot Surgical System<\/a> was less expensive than the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Da_Vinci_Surgical_System\" title=\"Da Vinci Surgical System\" rel=\"external_link\" target=\"_blank\">da Vinci Surgical System<\/a>, which cost $1 million. The cost of an operation through telesurgery is not precise but must pay for the surgical system, the surgeon, and contribute to paying for a year\u2019s worth of ATM technology which runs between $100,000-$200,000.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2018)\">citation needed<\/span><\/a><\/i>]<\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"The_Lindbergh_Operation\">The Lindbergh Operation<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lindbergh_Operation\" class=\"mw-redirect\" title=\"Lindbergh Operation\" rel=\"external_link\" target=\"_blank\">Lindbergh Operation<\/a><\/div>\n<p>The first true and complete remote surgery was conducted on 7 September 2001 across the Atlantic Ocean, with French surgeon (Dr. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Jacques_Marescaux\" title=\"Jacques Marescaux\" rel=\"external_link\" target=\"_blank\">Jacques Marescaux<\/a>) in <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_York_City\" title=\"New York City\" rel=\"external_link\" target=\"_blank\">New York City<\/a> performing a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholecystectomy\" title=\"Cholecystectomy\" rel=\"external_link\" target=\"_blank\">cholecystectomy<\/a> on a 68-year-old female patient 6,230 km away in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Strasbourg\" title=\"Strasbourg\" rel=\"external_link\" target=\"_blank\">Strasbourg<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/France\" title=\"France\" rel=\"external_link\" target=\"_blank\">France<\/a>. It was named Operation Lindbergh.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charles_Lindbergh\" title=\"Charles Lindbergh\" rel=\"external_link\" target=\"_blank\">Charles Lindbergh<\/a>\u2019s pioneering <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transatlantic_flight\" title=\"Transatlantic flight\" rel=\"external_link\" target=\"_blank\">transatlantic flight<\/a> from New York to Paris. France Telecom provided the redundant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_fiber\" title=\"Optical fiber\" rel=\"external_link\" target=\"_blank\">fiberoptic<\/a> ATM lines to minimize latency and optimize connectivity, and Computer Motion provided a modified Zeus robotic system. After clinical evaluation of the complete solution in July 2001, the human operation was successfully completed on 9\/7\/2001.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p><p>The success and exposure of the procedure led the robotic team to use the same technology within Canada, this time using Bell Canada's public internet between Hamilton, Ontario and North Bay, Ontario (a distance of about 400 kilometers). While operation Lindbergh used the most expensive ATM fiber optics communication to ensure reliability and success of the first telesurgery, the follow on procedures in Canada used standard public internet which was provisioned with QOS using MPLS <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quality_of_service\" title=\"Quality of service\" rel=\"external_link\" target=\"_blank\">QOS-MPLS<\/a>. A series of complex laparoscopic procedures were performed where in this case, the expert clinician would support the surgeon who was less experienced, operating on his patient. This resulted in patient receiving the best care possible while remaining in their hometown, the less experienced surgeon gaining valuable experience, and the expert surgeon providing their expertise without travel. The robotic team's goal was to go from Lindbergh's proof of concept to a real-life solution. This was achieved with over <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.intersurgtech.com\/media.html\" target=\"_blank\">20 complex laparoscopic operations<\/a> between Hamilton and North Bay.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technology\">Technology<\/span><\/h2>\n<p>The speed of remote surgery is made possible through ATM technology, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Asynchronous_Transfer_Mode\" class=\"mw-redirect\" title=\"Asynchronous Transfer Mode\" rel=\"external_link\" target=\"_blank\">Asynchronous Transfer Mode<\/a>. \u201cAsynchronous Transfer Mode is a technology designed for the high-speed transfer of voice, video, and data through public and private networks using cell relay technology\u201d. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cell_relay\" title=\"Cell relay\" rel=\"external_link\" target=\"_blank\">Cell relay<\/a> technology is the method of using small fixed length packets or cells to transfer data between computers or network equipment and determines the speed at which information is transferred. ATM technology has a maximum speed of 10 Gbit\/s (Gigabits per second). This developed technology provides opportunities for more transatlantic surgeries similar to the Operation Lindbergh.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> During a surgery, the robot arm can use a different angle during a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic_surgery\" class=\"mw-redirect\" title=\"Laparoscopic surgery\" rel=\"external_link\" target=\"_blank\">laparoscopic surgery<\/a> than a tool in the surgeon\u2019s hand, providing easier movement. The da Vinci Surgical System, using \"Endowrist\" instruments, allows the surgeon seven degrees of rotation and a range of motion far greater than the human hand while filtering out the hand\u2019s natural tremor.<sup id=\"rdp-ebb-cite_ref-intuitivesurgical.com_2-2\" class=\"reference\"><a href=\"#cite_note-intuitivesurgical.com-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-murphy_8-0\" class=\"reference\"><a href=\"#cite_note-murphy-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>Since Operation Lindbergh, remote surgery has been conducted many times in numerous locations. To date Dr. Anvari, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic_surgery\" class=\"mw-redirect\" title=\"Laparoscopic surgery\" rel=\"external_link\" target=\"_blank\">laparoscopic<\/a> surgeon in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hamilton,_Ontario\" title=\"Hamilton, Ontario\" rel=\"external_link\" target=\"_blank\">Hamilton<\/a>, Canada, has conducted numerous remote surgeries on patients in <a href=\"https:\/\/en.wikipedia.org\/wiki\/North_Bay,_Ontario\" title=\"North Bay, Ontario\" rel=\"external_link\" target=\"_blank\">North Bay<\/a>, a city 400 kilometres from Hamilton.<sup id=\"rdp-ebb-cite_ref-CSIIAnvari_9-0\" class=\"reference\"><a href=\"#cite_note-CSIIAnvari-9\" rel=\"external_link\">[9]<\/a><\/sup> Even though he uses a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Virtual_private_network\" title=\"Virtual private network\" rel=\"external_link\" target=\"_blank\">VPN<\/a> over a non-dedicated fiberoptic connection that shares <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bandwidth_(computing)\" title=\"Bandwidth (computing)\" rel=\"external_link\" target=\"_blank\">bandwidth<\/a> with regular telecommunications data, Dr. Anvari has not had any connection problems during his procedures.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2014)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Rapid development of technology has allowed remote surgery rooms to become highly specialized. At the Advanced Surgical Technology Centre at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mount_Sinai_Hospital_(Toronto)\" title=\"Mount Sinai Hospital (Toronto)\" rel=\"external_link\" target=\"_blank\">Mt. Sinai Hospital<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toronto\" title=\"Toronto\" rel=\"external_link\" target=\"_blank\">Toronto<\/a>, Canada, the surgical room <a href=\"https:\/\/en.wikipedia.org\/wiki\/Speech_recognition\" title=\"Speech recognition\" rel=\"external_link\" target=\"_blank\">responds to the surgeon\u2019s voice commands<\/a> in order to control a variety of equipment at the surgical site, including the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lighting\" title=\"Lighting\" rel=\"external_link\" target=\"_blank\">lighting<\/a> in the operating room, the position of the operating table and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instruments\" class=\"mw-redirect\" title=\"Surgical instruments\" rel=\"external_link\" target=\"_blank\">surgical tools<\/a> themselves. With continuing advances in communication technologies, the availability of greater bandwidth and more powerful computers, the ease and cost effectiveness of deploying remote surgery units is likely to increase rapidly.\n<\/p><p>The possibility of being able to project the knowledge and the physical skill of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgeon<\/a> over long distances has many attractions. There is considerable research underway in the subject. The armed forces have an obvious interest since the combination of telepresence, teleoperation, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telerobotics\" title=\"Telerobotics\" rel=\"external_link\" target=\"_blank\">telerobotics<\/a> can potentially save the lives of battle casualties by providing them with prompt attention in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Field_hospital\" title=\"Field hospital\" rel=\"external_link\" target=\"_blank\">mobile operating theatres<\/a>.\n<\/p><p>Another potential advantage of having robots perform surgeries is accuracy. A study conducted at Guy\u2019s Hospital in <a href=\"https:\/\/en.wikipedia.org\/wiki\/London\" title=\"London\" rel=\"external_link\" target=\"_blank\">London<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/England\" title=\"England\" rel=\"external_link\" target=\"_blank\">England<\/a> compared the success of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney\" title=\"Kidney\" rel=\"external_link\" target=\"_blank\">kidney<\/a> surgeries in 304 dummy patients conducted traditionally as well as remotely and found that those conducted using robots were more successful in accurately targeting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_stone\" class=\"mw-redirect\" title=\"Kidney stone\" rel=\"external_link\" target=\"_blank\">kidney stones<\/a>.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>In 2015, another test was conducted on the lag time involved in the robotic surgery. A Florida hospital successfully tested lag time created by the Internet for a simulated robotic surgery in Ft. Worth, Texas, more than 1,200 miles away from the surgeon who was at the virtual controls. The team found out that the lag time in robotic surgeries, were insignificant. Roger Smith, CTO at the Florida Hospital Nicholson Center said that the team had concluded that, telesurgery is something that is possible and generally safe for large areas within the United States.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Unassisted_robotic_surgery\">Unassisted robotic surgery<\/span><\/h2>\n<p>As the techniques of expert surgeons are studied and stored in special computer systems, robots might one day be able to perform surgeries with little or no human input. Carlo Pappone, an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Italy\" title=\"Italy\" rel=\"external_link\" target=\"_blank\">Italian<\/a> surgeon, has developed a software program that uses data collected from several surgeons and thousands of operations to perform the surgery without human intervention.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Identifying_reliable_sources\" title=\"Wikipedia:Identifying reliable sources\" rel=\"external_link\" target=\"_blank\"><span title=\"The material near this tag may rely on an unreliable source. Could have sworn that my research turned up an article on how the original info on this had been garbled and propagated by the news media, and that the robot actually still had some human assistance. (December 2015)\">unreliable source?<\/span><\/a><\/i>]<\/sup> This could one day make expensive, complicated surgeries much more widely available, even to patients in regions which have traditionally lacked proper medical facilities.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Force-feedback_and_time_delay\">Force-feedback and time delay<\/span><\/h2>\n<p>The ability to carry out delicate manipulations relies greatly upon feedback. For example, it is easy to learn how much pressure is required to handle an egg. In robotic surgery, surgeons need to be able to perceive the amount of force being applied without directly touching the surgical tools. Systems known as force-feedback, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Haptic_technology\" title=\"Haptic technology\" rel=\"external_link\" target=\"_blank\">haptic technology<\/a>, have been developed to simulate this. Haptics is the science of touch. Any type of Haptic feedback provides a responsive force in opposition to the touch of the hand. Haptic technology in telesurgery, making a virtual image of a patient or incision, would allow a surgeon to see what they are working on as well as feel it. This technology is designed to give a surgeon the ability to feel tendons and muscles as if it were actually the patient's body.<sup id=\"rdp-ebb-cite_ref-murphy_8-1\" class=\"reference\"><a href=\"#cite_note-murphy-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> However these systems are very sensitive to time-delays such as those present in the networks used in remote surgery.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Depth_perception\">Depth perception<\/span><\/h2>\n<p>Being able to gauge the depth of an incision is crucial. Humans' <a href=\"https:\/\/en.wikipedia.org\/wiki\/Binocular_vision\" title=\"Binocular vision\" rel=\"external_link\" target=\"_blank\">binocular vision<\/a> makes this easy in a three-dimensional environment. However this can be much more difficult when the view is presented on a flat computer screen.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Possible_uses\">Possible uses<\/span><\/h2>\n<p>One possible use of remote surgery is the Trauma-Pod project conceived by the US military under the Defense Advanced Research Agency. This system is intended to aid wounded soldiers in the battlefield by making use of the skills of remotely located medical personnel.\n<\/p><p>Another future possibility could be the use of remote surgery during long space exploration missions.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Limitations\">Limitations<\/span><\/h2>\n<p>For now, remote surgery is not a widespread technology in part because it does not have sponsorship by the governments.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> Before its acceptance on a broader scale, many issues will need to be resolved. For example, established clinical protocols, training, and global compatibility of equipment must be developed. Also, there is still the need for an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anesthesiologist\" class=\"mw-redirect\" title=\"Anesthesiologist\" rel=\"external_link\" target=\"_blank\">anesthesiologist<\/a> and a backup surgeon to be present in case there is a disruption of communications or a malfunction in the robot. Nevertheless, Operation Lindbergh proved that the technology exists today to enable delivery of expert care to remote areas of the globe.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Waldo_(short_story)\" title=\"Waldo (short story)\" rel=\"external_link\" target=\"_blank\">Waldo (short story)<\/a> by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_A._Heinlein\" title=\"Robert A. Heinlein\" rel=\"external_link\" target=\"_blank\">Robert A. Heinlein<\/a>.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-sandor-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-sandor_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-sandor_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sandor, Jozsef; Haidegger, Tamas; Benyo, Zoltan (2012). \"Surgery in Space: The Future of Robotic Telesurgery\". <i>Surgical Endoscopy<\/i>. <b>26<\/b> (1): 681\u2013690.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Surgical+Endoscopy&rft.atitle=Surgery+in+Space%3A+The+Future+of+Robotic+Telesurgery&rft.volume=26&rft.issue=1&rft.pages=681-690&rft.date=2012&rft.aulast=Sandor&rft.aufirst=Jozsef&rft.au=Haidegger%2C+Tamas&rft.au=Benyo%2C+Zoltan&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-intuitivesurgical.com-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-intuitivesurgical.com_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-intuitivesurgical.com_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-intuitivesurgical.com_2-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Intuitive Surgical. 2012. \"The Da Vinci Surgical System.\" Intuitive Surgical. <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.intuitivesurgical.com\/products\/davinci_surgical_system\/\" target=\"_blank\">http:\/\/www.intuitivesurgical.com\/products\/davinci_surgical_system\/<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hanly, Miller; Kumar, Coste-Maniere; Talamini, Aurora; Schenkman (2006). \"Mentoring Console Improves\". <i>J Laparoendosc Adv Surg Tech A<\/i>. <b>5<\/b>: 445\u2013451.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Laparoendosc+Adv+Surg+Tech+A.&rft.atitle=Mentoring+Console+Improves&rft.volume=5&rft.pages=445-451&rft.date=2006&rft.aulast=Hanly&rft.aufirst=Miller&rft.au=Kumar%2C+Coste-Maniere&rft.au=Talamini%2C+Aurora&rft.au=Schenkman&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Morris, B (2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1681689\" target=\"_blank\">\"Robotic surgery: applications, limitations, and impact on surgical education\"<\/a>. <i>MedGenMed<\/i>. <b>7<\/b>: 72. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1681689\" target=\"_blank\">1681689<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16369298\" target=\"_blank\">16369298<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=MedGenMed&rft.atitle=Robotic+surgery%3A+applications%2C+limitations%2C+and+impact+on+surgical+education&rft.volume=7&rft.pages=72&rft.date=2005&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1681689&rft_id=info%3Apmid%2F16369298&rft.aulast=Morris&rft.aufirst=B&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1681689&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.intersurgtech.com\/media.html\" target=\"_blank\">http:\/\/www.intersurgtech.com\/media.html<\/a><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Event videos: <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.intersurgtech.com\/media.html\" target=\"_blank\">http:\/\/www.intersurgtech.com\/media.html<\/a><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Cisco. 1992. \"Guide to ATM Technology - ATM Technology Fundamentals [Cisco Catalyst 8500 Series Multiservice Switch Routers] - Cisco Systems.\" <a rel=\"external_link\" class=\"external free\" href=\"#wp1019851\">http:\/\/www.cisco.com\/en\/US\/products\/hw\/switches\/ps718\/products_technical_reference_chapter09186a00800eb6fb.html#wp1019851<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"#wp1019851\">Archived<\/a> 28 April 2012 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-murphy-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-murphy_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-murphy_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Murphy, Challacombe; Khan; Dasgupta (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2660512\" target=\"_blank\">\"Robotic Technology in Urology\"<\/a>. <i>Postgraduate Medical Journal<\/i>. <b>82<\/b> (973): 743\u2013747. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fpgmj.2006.048140\" target=\"_blank\">10.1136\/pgmj.2006.048140<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2660512\" target=\"_blank\">2660512<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Postgraduate+Medical+Journal&rft.atitle=Robotic+Technology+in+Urology&rft.volume=82&rft.issue=973&rft.pages=743-747&rft.date=2006&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2660512&rft_id=info%3Adoi%2F10.1136%2Fpgmj.2006.048140&rft.aulast=Murphy&rft.aufirst=Challacombe&rft.au=Khan&rft.au=Dasgupta&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2660512&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-CSIIAnvari-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-CSIIAnvari_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.csii.ca\/about_csii\/leadership\/dr_mehran_anvari\" target=\"_blank\">\"Dr. Mehran Anvari\"<\/a>. Centre for Surgical Invention & Innovation<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">19 August<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Dr.+Mehran+Anvari&rft.pub=Centre+for+Surgical+Invention+%26+Innovation&rft_id=http%3A%2F%2Fwww.csii.ca%2Fabout_csii%2Fleadership%2Fdr_mehran_anvari&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Revill, Jo (5 October 2002). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.theguardian.com\/society\/2002\/oct\/06\/health.medicineandhealth\" target=\"_blank\">\"<span class=\"cs1-kern-left\">'<\/span>Remote' surgery turning point\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Guardian\" title=\"The Guardian\" rel=\"external_link\" target=\"_blank\">The Guardian<\/a><\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Guardian&rft.atitle=%27Remote%27+surgery+turning+point&rft.date=2002-10-05&rft.aulast=Revill&rft.aufirst=Jo&rft_id=https%3A%2F%2Fwww.theguardian.com%2Fsociety%2F2002%2Foct%2F06%2Fhealth.medicineandhealth&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rawscience.tv\/hospital-tests-lag-time-for-remote-surgery-12000-miles-away\/\" target=\"_blank\">\"Hospital Tests Lag Time for Remote Surgery 12,000 Miles Away\"<\/a>. <i>Raw Science<\/i>. 2015-07-15<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-09-20<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Raw+Science&rft.atitle=Hospital+Tests+Lag+Time+for+Remote+Surgery+12%2C000+Miles+Away&rft.date=2015-07-15&rft_id=http%3A%2F%2Fwww.rawscience.tv%2Fhospital-tests-lag-time-for-remote-surgery-12000-miles-away%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Mearian, Lucas. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.computerworld.com\/article\/2927471\/healthcare-it\/robot-performs-test-surgery-1200-miles-away-from-doctor.html\" target=\"_blank\">\"Hospital tests lag time for robotic surgery 1,200 miles away from doctor\"<\/a>. <i>Computerworld<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-09-20<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Computerworld&rft.atitle=Hospital+tests+lag+time+for+robotic+surgery+1%2C200+miles+away+from+doctor&rft.aulast=Mearian&rft.aufirst=Lucas&rft_id=https%3A%2F%2Fwww.computerworld.com%2Farticle%2F2927471%2Fhealthcare-it%2Frobot-performs-test-surgery-1200-miles-away-from-doctor.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060820022121\/http:\/\/www.dlmag.com\/1653\/robot-successfully-completes-unassisted-heart-surgery.html\" target=\"_blank\">Robot Successfully Completes Unassisted Heart Surgery Digital Lifestyle Magazine @ dlmag.com<\/a><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Immersion Corporation. 2012. \"Haptic Technology\".<\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Rosen, Jacob, Blake Hannaford, and Richard M. Satava. 2010. Surgical Robotics: Systems Applications and Visions. Springer.<\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.intersurgtech.com\/tele-medicine.html\" target=\"_blank\">Article and Media Gallery for telesurgery<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.pbs.org\/wnet\/innovation\/episode7_essay1.html\" target=\"_blank\">PBS article on telesurgery<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mtsinai.on.ca\/Publications\/YHRFall2001\/Hospital\/virtualreality.htm\" target=\"_blank\">Using remote surgery as a teaching tool<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/electronics.howstuffworks.com\/robotic-surgery.htm\" target=\"_blank\">How robotic surgery works<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.pulseplanet.com\/archive\/Aug96\/1290.html\" target=\"_blank\">Article in Pulse of the Planet about remote surgery<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/news.bbc.co.uk\/1\/hi\/sci\/tech\/1552211.stm\" target=\"_blank\">BBC News SCI\/TECH -- First transatlantic surgery<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.haivision.com\/download-center\/case-studies\/telesurgery-cmas\" target=\"_blank\">High Performance Network Video in support of Telesurgery \/ NEEMO7 Mission - Revolutionary Telemedicine Techniques<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20061106000002\/http:\/\/www.dlmag.com\/1653\/robot-successfully-completes-unassisted-heart-surgery.html\" target=\"_blank\">Robot Successfully Completes Unassisted Heart Surgery<\/a><\/li><\/ul>\n\n<p class=\"mw-empty-elt\">\n<\/p>\n<p><!-- \nNewPP limit report\nParsed by mw1330\nCached time: 20181204023733\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.320 seconds\nReal time usage: 0.412 seconds\nPreprocessor visited node count: 1129\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 33965\/2097152 bytes\nTemplate argument size: 2115\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 25619\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.169\/10.000 seconds\nLua memory usage: 3.77 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 344.451 1 -total\n<\/p>\n<pre>31.43% 108.251 4 Template:Cite_journal\n26.62% 91.688 2 Template:Citation_needed\n26.16% 90.104 3 Template:Fix\n13.39% 46.114 5 Template:Category_handler\n11.04% 38.013 3 Template:Delink\n 7.71% 26.562 1 Template:Unreliable_source?\n 5.66% 19.501 1 Template:Use_dmy_dates\n 4.79% 16.492 1 Template:Telemedicine_navbox\n 4.59% 15.824 3 Template:Cite_news\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:586307-1!canonical and timestamp 20181204023732 and revision id 871819876\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_surgery\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214706\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.010 seconds\nReal time usage: 0.137 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 131.048 1 - wikipedia:Remote_surgery\n100.00% 131.048 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8216-0!*!*!*!*!*!* and timestamp 20181217214706 and revision id 27027\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Remote_surgery\">https:\/\/www.limswiki.org\/index.php\/Remote_surgery<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","030820c81ed47c2bd6404f897e7a000a_images":[],"030820c81ed47c2bd6404f897e7a000a_timestamp":1545083226,"03e059abf77d6db7236b223c1f58f951_type":"article","03e059abf77d6db7236b223c1f58f951_title":"Politzerization","03e059abf77d6db7236b223c1f58f951_url":"https:\/\/www.limswiki.org\/index.php\/Politzerization","03e059abf77d6db7236b223c1f58f951_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPolitzerization\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t The Politzer maneuver, original illustration of 1863\nPolitzerization, also called the Politzer maneuver or method, is a medical procedure that involves inflating the middle ear by blowing air up the nose during the act of swallowing. It is often performed to reopen the Eustachian tube and equalise pressure in the sinuses. \nThe procedure was derived from a medical experiment first performed by \u00c1d\u00e1m Politzer of Vienna that involved studying the air movement through the Eustachian tube by connecting a manometer to the external auditory canal meatus and another manometer in the pharynx. His first results on the technique were published in 1861 and he introduced a pear-shaped rubber air-bag for performing the procedure in 1863, which came to be known as a Politzer bag. This system was far more practical and less difficult for the patient than catheterizing the Eustachian tube and brought fame to Politzer.\n\nUse in clinical devices \nOne device that utilizes Politzeration is the EarPopper, developed by Shlomo Silman, Ph.D., professor of hearing sciences and audiology at Brooklyn College, CUNY, and otolaryngologist Daniel Arick, M.D. The EarPopper is a hand-held, battery-operated device that delivers controlled air flow through the nostril and can be used by the patient without medical supervision. Clinical studies have demonstrated the device's efficacy in the treatment of ear blockage caused by Eustachian tube dysfunction[1] and otitis media with effusion.[2]\n\nReferences \n\n\n^ Silman & Arick: \"Efficacy of a Modified Politzer Apparatus in Management of Eustachian Tube Dysfunction in Adults\", Journal of the American Academy of Audiology, October 1999; Volume 10, No. 9 \n\n^ Daniel S. Arick, MD, FACS; Shlomo Silman, PhD: \"Nonsurgical home treatment of middle ear effusion and associated hearing loss in children. Part I: Clinical trial and Part II: Validation study\", ENT-Ear, Nose & Throat Journal, September 2005 \u2022 Volume 84, Number 9 \n\n\n\"Adam Politzer\". American Academy of Otolaryngology\u2212Head and Neck Surgery. Retrieved February 2, 2005 . \n\"Politzerization\". Dorlands Medical Dictionary. Retrieved February 2, 2005 . \n\"Politzer' Method\". Dorlands Medical Dictionary. Retrieved February 2, 2005 . \nExternal links \nAdam Politzer. ENTLink.\nMudry, A. The Role of Adam Politzer in the History of Otology. Am. J. Otol. 21:753-763, 2000.\nWebsite of the EarPopper medical device, www.earpopper.com\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Politzerization\">https:\/\/www.limswiki.org\/index.php\/Politzerization<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:45.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 476 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","03e059abf77d6db7236b223c1f58f951_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Politzerization skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Politzerization<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Politzerization2.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/c\/c7\/Politzerization2.JPG\/250px-Politzerization2.JPG\" width=\"250\" height=\"176\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Politzerization2.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The Politzer maneuver, original illustration of 1863<\/div><\/div><\/div>\n<p><b>Politzerization<\/b>, also called the <b>Politzer maneuver<\/b> or <b>method<\/b>, is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_procedure\" title=\"Medical procedure\" rel=\"external_link\" target=\"_blank\">medical procedure<\/a> that involves inflating the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Middle_ear\" title=\"Middle ear\" rel=\"external_link\" target=\"_blank\">middle ear<\/a> by blowing air up the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_nose\" title=\"Human nose\" rel=\"external_link\" target=\"_blank\">nose<\/a> during the act of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Swallowing\" title=\"Swallowing\" rel=\"external_link\" target=\"_blank\">swallowing<\/a>. It is often performed to reopen the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eustachian_tube\" title=\"Eustachian tube\" rel=\"external_link\" target=\"_blank\">Eustachian tube<\/a> and equalise pressure in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paranasal_sinus\" class=\"mw-redirect\" title=\"Paranasal sinus\" rel=\"external_link\" target=\"_blank\">sinuses<\/a>. \n<\/p><p>The procedure was derived from a medical experiment first performed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/%C3%81d%C3%A1m_Politzer\" title=\"\u00c1d\u00e1m Politzer\" rel=\"external_link\" target=\"_blank\">\u00c1d\u00e1m Politzer<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vienna\" title=\"Vienna\" rel=\"external_link\" target=\"_blank\">Vienna<\/a> that involved studying the air movement through the Eustachian tube by connecting a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manometer\" class=\"mw-redirect\" title=\"Manometer\" rel=\"external_link\" target=\"_blank\">manometer<\/a> to the external <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ear\" title=\"Ear\" rel=\"external_link\" target=\"_blank\">auditory canal meatus<\/a> and another manometer in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_pharynx\" class=\"mw-redirect\" title=\"Human pharynx\" rel=\"external_link\" target=\"_blank\">pharynx<\/a>. His first results on the technique were published in 1861 and he introduced a pear-shaped rubber air-bag for performing the procedure in 1863, which came to be known as a Politzer bag. This system was far more practical and less difficult for the patient than catheterizing the Eustachian tube and brought fame to Politzer.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Use_in_clinical_devices\">Use in clinical devices<\/span><\/h2>\n<p>One device that utilizes Politzeration is the EarPopper, developed by Shlomo Silman, Ph.D., professor of hearing sciences and audiology at Brooklyn College, CUNY, and otolaryngologist Daniel Arick, M.D. The EarPopper is a hand-held, battery-operated device that delivers controlled air flow through the nostril and can be used by the patient without medical supervision. Clinical studies have demonstrated the device's efficacy in the treatment of ear blockage caused by Eustachian tube dysfunction<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otitis_media\" title=\"Otitis media\" rel=\"external_link\" target=\"_blank\">otitis media with effusion<\/a>.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Silman & Arick: \"Efficacy of a Modified Politzer Apparatus in Management of Eustachian Tube Dysfunction in Adults\", <i>Journal of the American Academy of Audiology<\/i>, October 1999; Volume 10, No. 9<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Daniel S. Arick, MD, FACS; Shlomo Silman, PhD: \"Nonsurgical home treatment of middle ear effusion and associated hearing loss in children. Part I: Clinical trial and Part II: Validation study\", <i>ENT-Ear, Nose & Throat Journal<\/i>, September 2005 \u2022 Volume 84, Number 9<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<ul><li><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/entnet.org\/museum\/politzer.cfm\" target=\"_blank\">\"Adam Politzer\"<\/a>. <i>American Academy of Otolaryngology\u2212Head and Neck Surgery<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">February 2,<\/span> 2005<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=American+Academy+of+Otolaryngology%E2%88%92Head+and+Neck+Surgery&rft.atitle=Adam+Politzer&rft_id=http%3A%2F%2Fentnet.org%2Fmuseum%2Fpolitzer.cfm&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolitzerization\" class=\"Z3988\"><\/span><\/li>\n<li><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/merckmedicus.com\/ppdocs\/us\/common\/dorlands\/dorland\/dmd-p-055.htm#1081192\" target=\"_blank\">\"Politzerization\"<\/a>. <i>Dorlands Medical Dictionary<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">February 2,<\/span> 2005<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Dorlands+Medical+Dictionary&rft.atitle=Politzerization&rft_id=http%3A%2F%2Fmerckmedicus.com%2Fppdocs%2Fus%2Fcommon%2Fdorlands%2Fdorland%2Fdmd-p-055.htm%231081192&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolitzerization\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/merckmedicus.com\/ppdocs\/us\/common\/dorlands\/dorland\/dmd-m-026.htm#10017969\" target=\"_blank\">\"Politzer' Method\"<\/a>. <i>Dorlands Medical Dictionary<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">February 2,<\/span> 2005<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Dorlands+Medical+Dictionary&rft.atitle=Politzer%27+Method&rft_id=http%3A%2F%2Fmerckmedicus.com%2Fppdocs%2Fus%2Fcommon%2Fdorlands%2Fdorland%2Fdmd-m-026.htm%2310017969&rfr_id=info%3Asid%2Fen.wikipedia.org%3APolitzerization\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060301005455\/http:\/\/entlink.net\/museum\/politzer.cfm?renderforprint=1\" target=\"_blank\">Adam Politzer<\/a>. ENTLink.<\/li>\n<li>Mudry, A. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060108173810\/http:\/\/www.politzersociety.org\/Adam\/Adam2.htm\" target=\"_blank\">The Role of Adam Politzer in the History of Otology<\/a>. Am. J. Otol. 21:753-763, 2000.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.earpopper.com\" target=\"_blank\">Website of the EarPopper medical device, www.earpopper.com<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1250\nCached time: 20181126082857\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.084 seconds\nReal time usage: 0.110 seconds\nPreprocessor visited node count: 176\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 4235\/2097152 bytes\nTemplate argument size: 79\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 5624\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.049\/10.000 seconds\nLua memory usage: 1.74 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 90.531 1 -total\n<\/p>\n<pre>77.70% 70.345 3 Template:Cite_web\n22.05% 19.961 1 Template:Reflist\n 3.16% 2.865 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1459634-1!canonical and timestamp 20181126082857 and revision id 832749065\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Politzerization\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214705\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.008 seconds\nReal time usage: 0.135 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 130.150 1 - wikipedia:Politzerization\n100.00% 130.150 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8570-0!*!*!*!*!*!* and timestamp 20181217214705 and revision id 24998\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Politzerization\">https:\/\/www.limswiki.org\/index.php\/Politzerization<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","03e059abf77d6db7236b223c1f58f951_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/c\/c7\/Politzerization2.JPG"],"03e059abf77d6db7236b223c1f58f951_timestamp":1545083225,"91138ae233fb9e17b5a681bfec9b3c6a_type":"article","91138ae233fb9e17b5a681bfec9b3c6a_title":"Osseointegration","91138ae233fb9e17b5a681bfec9b3c6a_url":"https:\/\/www.limswiki.org\/index.php\/Osseointegration","91138ae233fb9e17b5a681bfec9b3c6a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tOsseointegration\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tCompare osseoincorporation and osteosynthesis.\nOsseointegration (from Latin ossum \"bone\" and integrare \"to make whole\") is the direct structural and functional connection between living bone and the surface of a load-bearing artificial implant (\"load-bearing\" as defined by Albrektsson et al. in 1981). A more recent definition (by Schroeder et al.) defines osseointegration as \"functional ankylosis (bone adherence)\", where new bone is laid down directly on the implant surface and the implant exhibits mechanical stability (also known as primary stability \u2013 i.e., resistance to destabilization by mechanical agitation or shear forces). Osseointegration has enhanced the science of medical bone and joint replacement techniques as well as dental implants and improving prosthetics for amputees.\n\nContents \n\n1 Definition \n2 History \n3 Mechanism \n4 Technique \n\n4.1 Advances in materials engineering: metal foams \n\n\n5 Testing procedures \n6 Applications \n7 See also \n8 Notes and references \n9 Further reading \n10 External links \n\n\nDefinition \nOsseointegration is also defined as: \"the formation of a direct interface between an implant and bone, without intervening soft tissue\".[1] Osseointegrated implant is a type of implant defined as \"an endosteal implant containing pores into which osteoblasts and supporting connective tissue can migrate\".[2] Applied to oral implantology, this thus refers to bone grown right up to the implant surface without interposed soft tissue layer. No scar tissue, cartilage or ligament fibers are present between the bone and implant surface. The direct contact of bone and implant surface can be verified microscopically.\nOsseointegration may also be defined as :\n\nOsseous integration, the apparent direct attachment or connection of osseous tissue to an inert alloplastic material without intervening connective tissue.\nThe process and resultant apparent direct connection of the endogenous material surface and the host bone tissues without intervening connective tissue.\nThe interface between alloplastic material and bone.\nHistory \n Titanium implant (black) integrated into bone (red): Histologic section\nOsseointegration was first observed\u2014albeit not explicitly stated\u2014by Bothe, Beaton, and Davenport in 1940.[3][4] Bothe et al. were the first researchers to implant titanium in an animal and remarked how it had the tendency to fuse with bone.[3][4] Bothe et al. reported that due to the elemental nature of the titanium, its strength, and its hardness, it had great potential to be used as future prosthesis material.[3][4] Osseointegration was later described by Gottlieb Leventhal in 1951.[3][5] Leventhal placed titanium screws in rat femurs and remarked how \"At the end of 6 weeks, the screws were slightly tighter than when originally put in; at 12 weeks, the screws were more difficult to remove; and at the end of 16 weeks, the screws were so tight that in one specimen the femur was fractured when an attempt was made to remove the screw. Microscopic examinations of the bone structure revealed no reaction to the implants. The trabeculation appeared to be perfectly normal.\"[3][5] The reactions described by Leventhal and Bothe et al. would later be coined into the term \"osseointegration\" by Per-Ingvar Br\u00e5nemark of Sweden. In 1952, Br\u00e5nemark conducted an experiment where he utilized a titanium implant chamber to study blood flow in rabbit bone. At the conclusion of the experiment, when it became time to remove the titanium chambers from the bone, he discovered that the bone had integrated so completely with the implant that the chamber could not be removed. Br\u00e5nemark called this \"osseointegration\", and, like Bothe et al. and Leventhal before him, saw the possibilities for human use.[3][4][5]\nIn dental medicine the implementation of osseointegration started in the mid-1960s as a result of Br\u00e5nemark's work.[6][7][8][9] In 1965 Br\u00e5nemark, who was at the time Professor of Anatomy at the University of Gothenburg, placed dental implants into the first human patient \u2013 G\u00f6sta Larsson. This patient had a cleft palate defect and required implants to support a palatal obturator. G\u00f6sta Larsson died in 2005, with the original implants still in place after 40 years of function.[10]\nIn the mid-1970s Br\u00e5nemark entered into a commercial partnership with the Swedish defense company Bofors to manufacture dental implants and the instrumentation required for their placement. Eventually an offshoot of Bofors, Nobel Pharma, was created to concentrate on this product line. Nobel Pharma subsequently became Nobel Biocare.[10]\nBr\u00e5nemark spent almost 30 years fighting the scientific community for acceptance of osseointegration as a viable treatment. In Sweden he was often openly ridiculed at scientific conferences. His university stopped funding for his research, forcing him to open a private clinic to continue the treatment of patients. Eventually an emerging breed of young academics started to notice the work being performed in Sweden. Toronto's George Zarb, a Maltese-born Canadian prosthodontist, was instrumental in bringing the concept of osseointegration to the wider world. The 1983 Toronto Conference is generally considered to be the turning point, when finally the worldwide scientific community accepted Br\u00e5nemark's work. Today osseointegration is a highly predictable and commonplace treatment modality.[10]\nMore recently since 2010 Al Muderis in Sydney Australia utilised a high tensile strength titanium implant with high prose plasma sprayed surface as an intramedullary prosthesis that is inserted into the bone residuum of amputees and then connect through an opening in the skin to a robotic limb prosthesis. This allows amputees to mobilise with more comfort and less energy consumption. Al Muderis also published the first series of combining osseointegration prosthesis with Joint replacement enabling below knee amputees with knee arthritis or short residual bone to mobilise without the need of a socket prosthesis.[11]\n\n<\/p>\nOn December 7, 2015, two Operation Iraqi Freedom\/Operation Enduring Freedom veterans, Bryant Jacobs and Ed Salau, will be the first in America to get a percutaneous osseointegrated prosthesis.[12] During the first stage, doctors at Salt Lake Veterans Affairs Hospital will embed a titanium stud in the femur of each patient. About six weeks later, they will go back and attach the docking mechanism for the prosthesis.This article needs to be updated. Please update this article to reflect recent events or newly available information. (November 2018)\nMechanism \nSee also: Titanium biocompatibility\nOsseointegration is a dynamic process in which characteristics of the implant (i.e. macrogeometry, surface properties, etc.) play a role in modulating molecular and cellular behavior. While osseointegration has been observed using different materials, it is most often used to describe the reaction of bone tissues to titanium, or titanium coated with calcium phosphate derivatives.[13] It was previously thought that titanium implants were retained in bone through the action of mechanical stabilization or interfacial bonding. Alternatively, calcium phosphate coated implants were thought to be stabilized via chemical bonding. It is now known that both calcium phosphate coated implants and titanium implants are stabilized chemically with bone, either through direct contact between calcium and titanium atoms, or by the bonding to a cement line-like layer at the implant\/bone interface.[14][15] While there are some differences (e.g. like the lack of chondrogenic progenitors), osseointegration occurs through the same mechanisms as bone fracture healing.[16][17]\n\nTechnique \nFor osseointegrated dental implants, metallic, ceramic, and polymeric materials have been used,[2] in particular titanium.[18] To be termed osseointegration the connection between the bone and the implant need not be 100 percent, and the essence of osseointegration derives more from the stability of the fixation than the degree of contact in histologic terms. In short it represents a process whereby clinically asymptomatic rigid fixation of alloplastic materials is achieved, and maintained, in bone during functional loading.[19] Implant healing times and initial stability are a function of implant characteristics. For example, implants utilizing a screw-root form design achieve high initial mechanical stability through the action of their screws against the bone. Following placement of the implant, healing typically takes several weeks or months before the implant is fully integrated into the surrounding bone. First evidence of integration occurs after a few weeks, while more robust connection is progressively effected over the next months or years.[20] Implants that possess a screw-root form design result in bone resorption followed by interfacial bone remodeling and growth around the implant.[21]\nImplants utilizing a plateau-root form design (or screw-root form implants with a wide enough gap between the pitch of the screws) undergo a different mode of peri-implant ossification. Unlike the aforementioned screw-root form implants, plateau-root form implants exhibit de novo bone formation on the implant surface.[22] The type of bone healing exhibited by plateau-root form implants is known as intramembranous-like healing.[21]\nThough the osseointegrated interface becomes resistant to external shocks over time, it may be damaged by prolonged adverse stimuli and overload, which may result in implant failure.[23][24] In studies performed using \"Mini dental implants,\" it was noted that the absence of micromotion at the bone-implant interface was necessary to enable proper osseointegration.[25] Further, it was noted that there is a critical threshold of micromotion above which a fibrous encapsulation process occurs, rather than osseointegration.[26]\nOther complications may arise even in the absence of external impact. One issue is the growing of cement.[27] In normal cases, the absence of cementum on the implant surface prevents the attachment of collagen fibers. This is normally the case due to the absence of cementum progenitor cells in the area receiving the implant. However, when such cells are present, cement may form on or around the implant surface, and a functional collagen attachment may attach to it.[28]\n\nAdvances in materials engineering: metal foams \nSince 2005, a number of orthopedic device manufacturers have introduced products that feature porous metal construction.[29][30][31] Clinical studies on mammals have shown that porous metals, such as titanium foam, may allow the formation of vascular systems within the porous area.[32] For orthopedic uses, metals such as tantalum or titanium are often used, as these metals exhibit high tensile strength and corrosion resistance with excellent biocompatibility.\nThe process of osseointegration in metal foams is similar to that in bone grafts. The porous bone-like properties of the metal foam contribute to extensive bone infiltration, allowing osteoblast activity to take place. In addition, the porous structure allows for soft tissue adherence and vascularization within the implant. These materials are currently deployed in hip replacement, knee replacement and dental implant surgeries.\n\nTesting procedures \nThere are a number of methods used to gauge the level of osseointegration and the subsequent stability of an implant. One widely used diagnostic procedure is percussion analysis, where a dental instrument is tapped against the implant carrier.[33] The nature of the ringing that results is used as a qualitative measure of the implant\u2019s stability. An integrated implant will elicit a higher pitched \"crystal\" sound, whereas a non-integrated implant will elicit a dull, low-pitched sound.[34]\nAnother method is a reverse torque test, in which the implant carrier is unscrewed. If it fails to unscrew under the reverse torque pressure, the implant is stable. If the implant rotates under the pressure it is deemed a failure and removed.[35] This method comes at the risk of fracturing bone that is mid-way in the process of osseointegration.[33] It is also unreliable in determining the osseointegration potential of a bone region, as tests have yielded that a rotating implant can go on to be successfully integrated.[36]\nA non-invasive and increasingly implemented diagnostic method is resonance frequency analysis (RFA).[33] A resonance frequency analyzer device prompts vibrations in a small metal rod temporarily attached to the implant. As the rod vibrates, the probe reads its resonance frequency and translates it into an implant stability quotient (ISQ), which ranges from 1\u2013100, with 100 indicating the highest stability state. Values ranging between 57 and 82 are generally considered stable, though each case must be considered independently.[33]\n\nApplications \nDental implants are by far the main field of application\nRetention of a craniofacial prosthesis such as an artificial ear (ear prosthesis), maxillofacial reconstruction, eye (orbital prosthesis), or nose (nose prosthesis)\nBone anchored limb prostheses[37]\nBone anchored hearing conduction amplification (Bone anchored hearing aid)\nEyeborg perceive color through sound waves (sound conduction through bone)\nKnee and joint replacement\nSee also \n\n\n Medicine portal \n\nAbutment (dentistry)\nBritish Society of Oral Implantology\nEuropean Association for Osseointegration\nOral and maxillofacial surgery\nOsteosynthesis, reduction and internal fixation, which may use wires or implants\nPeriodontology\nProsthodontics\n\nNotes and references \n\n\n^ Miller, Benjamin F.; Keane, Claire B. (1992). Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health. Philadelphia: Saunders. ISBN 0-7216-3456-7. [page needed ] \n\n^ a b Mosby's Medical, Nursing & Allied Health Dictionary. St. Louis: Mosby. 2002. p. 1240. ISBN 0-323-01430-5. \n\n^ a b c d e f Rudy, Robert; Levi, Paul A; Bonacci, Fred J; Weisgold, Arnold S; Engler-Hamm, Daniel (2008). \"Intraosseous anchorage of dental prostheses: an early 20th century contribution\". Compend Contin Educ Dent. 29 (4): 220\u2013229. PMID 18524206. \n\n^ a b c d Bothe, RT; Beaton, KE; Davenport, HA (1940). \"Reaction of bone to multiple metallic implants\". Surg Gynecol Obstet. 71: 598\u2013602. \n\n^ a b c Leventhal, Gottlieb (1951). \"Titanium, a metal for surgery\". J Bone Joint Surg Am. 33-A (2): 473\u2013474. PMID 14824196. \n\n^ Br\u00e5nemark PI (September 1983). \"Osseointegration and its experimental background\". The Journal of Prosthetic Dentistry. 50 (3): 399\u2013410. doi:10.1016\/S0022-3913(83)80101-2. PMID 6352924. \n\n^ Br\u00e5nemark, Per-Ingvar; Zarb, George Albert; Albrektsson, Tomas (1985). Tissue-integrated prostheses: osseointegration in clinical dentistry. Chicago: Quintessence. ISBN 978-0-86715-129-9. [page needed ] \n\n^ Albrektsson, Tomas; Zarb, George A. (1989). The Branemark osseointegrated implant. Chicago: Quintessence Pub. Co. ISBN 978-0-86715-208-1. [page needed ] \n\n^ Beumer, John; Lewis, Steven (1989). The Branemark implant system: clinical and laboratory procedures. St. Louis: Ishiyaku EuroAmerica. ISBN 0-912791-62-4. [page needed ] \n\n^ a b c \nClose to the Edge - Br\u00e5nemark and the Development of Osseointegration, edited by Elaine McClarence, Quintessence 2003. \n\n^ Khemka A, Frossard L, Lord SJ, Bosley B, Al Muderis M (Jul 2015). \"Osseointegrated total knee replacement connected to a lower limb prosthesis: 4 cases\". Acta Orthop. 86 (6): 740\u20134. doi:10.3109\/17453674.2015.1068635. PMC 4750776 . PMID 26145721. \n\n^ \"Veteran amputees to undergo first ever prosthetic implants | KSL.com\". www.ksl.com. Retrieved 2015-12-04 . \n\n^ Albrektsson, T; Johansson, C (2001). \"Osteoinduction, osteoconduction and osseointegration\". Eur Spine J. 10 (2): S96\u2013S101. doi:10.1007\/s005860100282. PMC 3611551 . \n\n^ Davies, J (2003). \"Understanding peri-implant endosseous healing\". J Dent Ed. 67 (8): 932\u2013949. \n\n^ Thuvander, M; Andersson, M (2014). \"Atomically resolved tissue integration\". Nano Lett. 14 (8): 4220\u20134223. doi:10.1021\/nl501564f. PMID 24989063. \n\n^ Colnot, C; Romero, DM; Huang, S; Rahman, J; Currey, JA; Nanci, A; Brunski, JB; Helms, JA (2007). \"Molecular analysis of healing at a bone-implant interface\". J Dent Res. 86 (9): 109\u2013118. PMID 17720856. \n\n^ Albrektsson, T; Branemark, PI; Hansson, HA; Lindstrom, J (1981). \"Osseointegrated titanium implants. Requirements for ensuring a long-lasting, direct bone-to- implant anchorage in man\". Acta Orthop Scand. 52 (2): 155\u2013170. doi:10.3109\/17453678108991776. PMID 7246093. \n\n^ Natali, Arturo N., ed. (2003). Dental biomechanics. Washington, DC: Taylor & Francis. pp. 69\u201387. ISBN 978-0-415-30666-9. \n\n^ Zarb, George A.; Albrektsson, Tomas (1991). \"Osseointegration: A requiem for the periodontal ligament?\". International Journal of Periodontology and Restorative Dentistry (11): 88\u201391. \n\n^ Albrektsson, Tomas; Berglundh, Tord; Lindhe, Jan (2003). \"Osseointegration: Historic Background and Current Concepts\". In Lindhe, Jan; Karring, Thorkild; Lang, Niklaus P. Clinical Periodontology and Implant Dentistry. Oxford: Blackwell Munksgaard. p. 815. ISBN 1-4051-0236-5. \n\n^ a b Coelho, P; Jimbo, R (2014). \"Osseointegration of metallic devices: current trends based on implant hardware design\". Arch Biochem Biophys. 561: 99\u2013108. doi:10.1016\/j.abb.2014.06.033. PMID 25010447. \n\n^ Berglundh, T; Abrahamsson, I; Lang, N; Lindhe, J (2003). \"De novo alveolar bone formation adjacent to endosseous implants\". Clin. Oral Impl. Res. 14 (3): 251\u2013262. doi:10.1034\/j.1600-0501.2003.00972.x. PMID 12755774. \n\n^ Albrektsson, Tomas; Berglundh, Tord; Lindhe, Jan (2003). \"Osseointegration: Historic Background and Current Concepts\". In Lindhe, Jan; Karring, Thorkild; Lang, Niklaus P. Clinical Periodontology and Implant Dentistry. Oxford: Blackwell Munksgaard. p. 816. ISBN 1-4051-0236-5. \n\n^ Isidor F (June 1996). \"Loss of osseointegration caused by occlusal load of oral implants. A clinical and radiographic study in monkeys\". Clinical Oral Implants Research. 7 (2): 143\u201352. doi:10.1034\/j.1600-0501.1996.070208.x. PMID 9002833. \n\n^ Brunski JB (June 1999). \"In vivo bone response to biomechanical loading at the bone\/dental-implant interface\". Advances in Dental Research. 13: 99\u2013119. doi:10.1177\/08959374990130012301. PMID 11276755. \n\n^ Szmukler-Moncler S, Salama H, Reingewirtz Y, Dubruille JH (1998). \"Timing of loading and effect of micromotion on bone-dental implant interface: review of experimental literature\". Journal of Biomedical Materials Research. 43 (2): 192\u2013203. doi:10.1002\/(SICI)1097-4636(199822)43:2<192::AID-JBM14>3.0.CO;2-K. PMID 9619438. \n\n^ Pauletto N, Lahiffe BJ, Walton JN (1999). \"Complications associated with excess cement around crowns on osseointegrated implants: a clinical report\". The International Journal of Oral & Maxillofacial Implants. 14 (6): 865\u20138. PMID 10612925. \n\n^ Bernard, George W.; Carranza, Ferritin A.; Jovanovic, Sascha A. (1996). \"Biologic Aspects of Dental Implants\". In Carranza, Ferm\u00edn A.; Newman, Michael G. Clinical Periodontology. pp. 685\u20139. ISBN 978-0-7216-6728-7. \n\n^ Biomet Orthopedics, Regenerex\u00ae Porous Titanium Construct, http:\/\/www.biomet.com\/orthopedics\/productDetail.cfm?category=2&product=231 \n\n^ Zimmer Orthopedics, Trabeluar Metal Technology, http:\/\/www.zimmer.com\/ctl?template=CP&op=global&action=1&id=33 \n\n^ Zimmer Cancellous-Structured Titanium Porous Coating, http:\/\/www.zimmer.com\/ctl?op=global&action=1&id=7876&template=MP \n\n^ Osseointegration with Titanium Foam in Rabbit Femur, YouTube: https:\/\/www.youtube.com\/watch?v=hdscnna5r1Q \n\n^ a b c d Implant Dentistry - A Rapidly Evolving Practice. 2011. pp. 111\u2013126. \n\n^ \"Current trends to measure implant stability\". Journal of the Indian Prosthodontic Society. 16: 124\u2013130. 2016. doi:10.4103\/0972-4052.176539. \n\n^ \"Methods Used to Assess Implant Stability: Current Status\" (PDF) . International Journal of Oral and Maxillofacial Implants. 22: 742\u2013754. 2007. \n\n^ Ivanoff, C. J.; Sennerby, L.; Lekholm, U. (1997-08-01). \"Reintegration of mobilized titanium implants. An experimental study in rabbit tibia\". International Journal of Oral and Maxillofacial Surgery. 26 (4): 310\u2013315. doi:10.1016\/s0901-5027(97)80878-8. ISSN 0901-5027. PMID 9258729. \n\n^ Hagberg K, Br\u00e5nemark R (2009). \"One hundred patients treated with osseointegrated transfemoral amputation prostheses--rehabilitation perspective\". Journal of Rehabilitation Research and Development. 46 (3): 331\u201344. PMID 19675986. \n\n \nTrabecular Metal Material: The Next Best Thing to BoneTM: http:\/\/www.trabecularmetal.zimmerdental.com\/Implant\/imp_home.aspx\nFurther reading \nZarb GA, Schmitt A (July 1990). \"The longitudinal clinical effectiveness of osseointegrated dental implants: the Toronto Study. Part II: The prosthetic results\". The Journal of Prosthetic Dentistry. 64 (1): 53\u201361. doi:10.1016\/0022-3913(90)90153-4. PMID 2200880. \nApse P, Zarb GA, Schmitt A, Lewis DW (1991). \"The longitudinal effectiveness of osseointegrated dental implants. The Toronto Study: peri-implant mucosal response\". The International Journal of Periodontics & Restorative Dentistry. 11 (2): 94\u2013111. PMID 1718917. \nChaytor DV, Zarb GA, Schmitt A, Lewis DW (1991). \"The longitudinal effectiveness of osseointegrated dental implants. The Toronto Study: bone level changes\". The International Journal of Periodontics & Restorative Dentistry. 11 (2): 112\u201325. PMID 1938184. \nBarber AJ, Butterworth CJ, Rogers SN (January 2010). \"Systematic review of primary osseointegrated dental implants in head and neck oncology\". The British Journal of Oral & Maxillofacial Surgery. 49 (1): 29\u201336. doi:10.1016\/j.bjoms.2009.12.007. PMID 20079957. \nHultin M, Gustafsson A, Klinge B (February 2000). \"Long-term evaluation of osseointegrated dental implants in the treatment of partly edentulous patients\". Journal of Clinical Periodontology. 27 (2): 128\u201333. doi:10.1034\/j.1600-051x.2000.027002128.x. PMID 10703659. \nOliv\u00e9, Jordi; Aparicio, Carlos (1990). \"The periotest implant as a measure of osseointegrated oral implant stability\". The International Journal of Oral & Maxillofacial Implants. 5 (4): 390\u2013400. \nHolmgren EP, Seckinger RJ, Kilgren LM, Mante F (1998). \"Evaluating parameters of osseointegrated dental implants using finite element analysis--a two-dimensional comparative study examining the effects of implant diameter, implant shape, and load direction\". The Journal of Oral Implantology. 24 (2): 80\u20138. doi:10.1563\/1548-1336(1998)024<0080:EPOODI>2.3.CO;2. PMID 9835834. \nExternal links \nClinical research on osseointegrated dental implants\nvteDentistrySpecialties\nEndodontics\nOral and maxillofacial pathology\nOral and maxillofacial radiology\nOral and maxillofacial surgery\nOrthodontics and dentofacial orthopedics\nPediatric dentistry\nPeriodontics\nProsthodontics\nDental public health\nCosmetic dentistry\nDental implantology\nGeriatric dentistry\nRestorative dentistry\nForensic odontology\nDental traumatology\nHolistic dentistry\nDental surgery\nDental extraction\nTooth filling\nRoot canal therapy\nRoot end surgery\nScaling and root planing\nTeeth cleaning\nDental bonding\nTooth polishing\nTooth bleaching\nSocket preservation\nDental implant\nOrganisations\nAmerican Association of Orthodontists\nBritish Dental Association\nBritish Dental Health Foundation\nBritish Orthodontic Society\nCanadian Association of Orthodontists\nDental Technologists Association\nIndian Dental Association\nNational Health Service\nOrthodontic National Group\nOrthodontic Technicians Association\nGeneral Dental Council\nSee also\nIndex of oral health and dental articles\nOutline of dentistry and oral health\nOral hygiene\nDental fear\nDental instruments\nDental material\nInfant oral mutilation\nMouth assessment\n\nvtePhysiology of bone and cartilageBone\nBone density\nBone remodeling\nBone healing\nBone resorption\nOsseointegration\nOssification\nOsteolysis\nBone age\nPeriosteal reaction\nCartilage\nChondrogenesis\nJoint\nRange of motion\nTeeth\nChewing\nCementogenesis\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Osseointegration\">https:\/\/www.limswiki.org\/index.php\/Osseointegration<\/a>\n\t\t\t\t\tCategories: BiomaterialsHealthcare termsImplants (medicine)Hidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","91138ae233fb9e17b5a681bfec9b3c6a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Osseointegration skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Osseointegration<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">Compare <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseoincorporation\" title=\"Osseoincorporation\" rel=\"external_link\" target=\"_blank\">osseoincorporation<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteosynthesis\" title=\"Osteosynthesis\" rel=\"external_link\" target=\"_blank\">osteosynthesis<\/a>.<\/div>\n<p><b>Osseointegration<\/b> (from Latin <i>ossum<\/i> \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a>\" and <i>integrare<\/i> \"to make whole\") is the direct structural and functional connection between living <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> and the surface of a load-bearing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">artificial implant<\/a> (\"load-bearing\" as defined by Albrektsson et al. in 1981). A more recent definition (by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Schroeder\" title=\"Schroeder\" rel=\"external_link\" target=\"_blank\">Schroeder<\/a> et al.) defines osseointegration as \"functional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ankylosis\" title=\"Ankylosis\" rel=\"external_link\" target=\"_blank\">ankylosis<\/a> (bone adherence)\", where new bone is laid down directly on the implant surface and the implant exhibits <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mechanical_properties_of_biomaterials\" title=\"Mechanical properties of biomaterials\" rel=\"external_link\" target=\"_blank\">mechanical stability<\/a> (also known as <i>primary stability<\/i> \u2013 i.e., resistance to destabilization by or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shear_force\" title=\"Shear force\" rel=\"external_link\" target=\"_blank\">shear forces<\/a>). Osseointegration has enhanced the science of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medical<\/a> bone and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Replacement_joint\" class=\"mw-redirect\" title=\"Replacement joint\" rel=\"external_link\" target=\"_blank\">joint replacement<\/a> techniques as well as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental implants<\/a> and improving <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthetics<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amputee\" class=\"mw-redirect\" title=\"Amputee\" rel=\"external_link\" target=\"_blank\">amputees<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Definition\">Definition<\/span><\/h2>\n<p>Osseointegration is also defined as: \"the formation of a direct interface between an implant and bone, without intervening soft tissue\".<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> <b>Osseointegrated implant<\/b> is a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implant<\/a> defined as \"an endosteal implant containing pores into which osteoblasts and supporting connective tissue can migrate\".<sup id=\"rdp-ebb-cite_ref-mosby2002_2-0\" class=\"reference\"><a href=\"#cite_note-mosby2002-2\" rel=\"external_link\">[2]<\/a><\/sup> Applied to oral implantology, this thus refers to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> grown right up to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">implant<\/a> surface without interposed soft tissue layer. No <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scar\" title=\"Scar\" rel=\"external_link\" target=\"_blank\">scar tissue<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cartilage\" title=\"Cartilage\" rel=\"external_link\" target=\"_blank\">cartilage<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ligament\" title=\"Ligament\" rel=\"external_link\" target=\"_blank\">ligament<\/a> fibers are present between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> and implant surface. The direct contact of bone and implant surface can be verified <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microscope\" title=\"Microscope\" rel=\"external_link\" target=\"_blank\">microscopically<\/a>.\n<\/p><p>Osseointegration may also be defined as :\n<\/p>\n<ol><li>Osseous integration, the apparent direct attachment or connection of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osseous_tissue\" class=\"mw-redirect\" title=\"Osseous tissue\" rel=\"external_link\" target=\"_blank\">osseous tissue<\/a> to an inert alloplastic material without intervening connective tissue.<\/li>\n<li>The process and resultant apparent direct connection of the endogenous material surface and the host bone tissues without intervening connective tissue.<\/li>\n<li>The interface between alloplastic material and bone.<\/li><\/ol>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Osseointegration_Histology.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bc\/Osseointegration_Histology.jpg\/220px-Osseointegration_Histology.jpg\" width=\"220\" height=\"143\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Osseointegration_Histology.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Titanium implant (black) integrated into bone (red): Histologic section<\/div><\/div><\/div>\n<p>Osseointegration was first observed\u2014albeit not explicitly stated\u2014by Bothe, Beaton, and Davenport in 1940.<sup id=\"rdp-ebb-cite_ref-Rudy_et_al._3-0\" class=\"reference\"><a href=\"#cite_note-Rudy_et_al.-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Bothe_et_al._4-0\" class=\"reference\"><a href=\"#cite_note-Bothe_et_al.-4\" rel=\"external_link\">[4]<\/a><\/sup> Bothe et al. were the first researchers to implant titanium in an animal and remarked how it had the tendency to fuse with bone.<sup id=\"rdp-ebb-cite_ref-Rudy_et_al._3-1\" class=\"reference\"><a href=\"#cite_note-Rudy_et_al.-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Bothe_et_al._4-1\" class=\"reference\"><a href=\"#cite_note-Bothe_et_al.-4\" rel=\"external_link\">[4]<\/a><\/sup> Bothe et al. reported that due to the elemental nature of the titanium, its strength, and its hardness, it had great potential to be used as future prosthesis material.<sup id=\"rdp-ebb-cite_ref-Rudy_et_al._3-2\" class=\"reference\"><a href=\"#cite_note-Rudy_et_al.-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Bothe_et_al._4-2\" class=\"reference\"><a href=\"#cite_note-Bothe_et_al.-4\" rel=\"external_link\">[4]<\/a><\/sup> Osseointegration was later described by Gottlieb Leventhal in 1951.<sup id=\"rdp-ebb-cite_ref-Rudy_et_al._3-3\" class=\"reference\"><a href=\"#cite_note-Rudy_et_al.-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Leventhal_5-0\" class=\"reference\"><a href=\"#cite_note-Leventhal-5\" rel=\"external_link\">[5]<\/a><\/sup> Leventhal placed titanium screws in rat femurs and remarked how \"At the end of 6 weeks, the screws were slightly tighter than when originally put in; at 12 weeks, the screws were more difficult to remove; and at the end of 16 weeks, the screws were so tight that in one specimen the femur was fractured when an attempt was made to remove the screw. Microscopic examinations of the bone structure revealed no reaction to the implants. The trabeculation appeared to be perfectly normal.\"<sup id=\"rdp-ebb-cite_ref-Rudy_et_al._3-4\" class=\"reference\"><a href=\"#cite_note-Rudy_et_al.-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Leventhal_5-1\" class=\"reference\"><a href=\"#cite_note-Leventhal-5\" rel=\"external_link\">[5]<\/a><\/sup> The reactions described by Leventhal and Bothe et al. would later be coined into the term \"osseointegration\" by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Per-Ingvar_Br%C3%A5nemark\" title=\"Per-Ingvar Br\u00e5nemark\" rel=\"external_link\" target=\"_blank\">Per-Ingvar Br\u00e5nemark<\/a> of Sweden. In 1952, Br\u00e5nemark conducted an experiment where he utilized a titanium implant chamber to study blood flow in rabbit bone. At the conclusion of the experiment, when it became time to remove the titanium chambers from the bone, he discovered that the bone had integrated so completely with the implant that the chamber could not be removed. Br\u00e5nemark called this \"osseointegration\", and, like Bothe et al. and Leventhal before him, saw the possibilities for human use.<sup id=\"rdp-ebb-cite_ref-Rudy_et_al._3-5\" class=\"reference\"><a href=\"#cite_note-Rudy_et_al.-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Bothe_et_al._4-3\" class=\"reference\"><a href=\"#cite_note-Bothe_et_al.-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Leventhal_5-2\" class=\"reference\"><a href=\"#cite_note-Leventhal-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dentistry\" title=\"Dentistry\" rel=\"external_link\" target=\"_blank\">dental medicine<\/a> the implementation of osseointegration started in the mid-1960s as a result of Br\u00e5nemark's work.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> In 1965 Br\u00e5nemark, who was at the time Professor of Anatomy at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Gothenburg\" title=\"University of Gothenburg\" rel=\"external_link\" target=\"_blank\">University of Gothenburg<\/a>, placed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implants\" class=\"mw-redirect\" title=\"Dental implants\" rel=\"external_link\" target=\"_blank\">dental implants<\/a> into the first human patient \u2013 G\u00f6sta Larsson. This patient had a cleft palate defect and required implants to support a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Palatal_obturator\" title=\"Palatal obturator\" rel=\"external_link\" target=\"_blank\">palatal obturator<\/a>. G\u00f6sta Larsson died in 2005, with the original implants still in place after 40 years of function.<sup id=\"rdp-ebb-cite_ref-mcclarence_10-0\" class=\"reference\"><a href=\"#cite_note-mcclarence-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>In the mid-1970s Br\u00e5nemark entered into a commercial partnership with the Swedish defense company <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bofors\" title=\"Bofors\" rel=\"external_link\" target=\"_blank\">Bofors<\/a> to manufacture dental implants and the instrumentation required for their placement. Eventually an offshoot of Bofors, Nobel Pharma, was created to concentrate on this product line. Nobel Pharma subsequently became Nobel Biocare.<sup id=\"rdp-ebb-cite_ref-mcclarence_10-1\" class=\"reference\"><a href=\"#cite_note-mcclarence-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>Br\u00e5nemark spent almost 30 years fighting the scientific community for acceptance of osseointegration as a viable treatment. In Sweden he was often openly ridiculed at scientific conferences. His university stopped funding for his research, forcing him to open a private clinic to continue the treatment of patients. Eventually an emerging breed of young academics started to notice the work being performed in Sweden. Toronto's George Zarb, a Maltese-born Canadian prosthodontist, was instrumental in bringing the concept of osseointegration to the wider world. The 1983 Toronto Conference is generally considered to be the turning point, when finally the worldwide scientific community accepted Br\u00e5nemark's work. Today osseointegration is a highly predictable and commonplace treatment modality.<sup id=\"rdp-ebb-cite_ref-mcclarence_10-2\" class=\"reference\"><a href=\"#cite_note-mcclarence-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<p>More recently since 2010 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Munjed_Al_Muderis\" title=\"Munjed Al Muderis\" rel=\"external_link\" target=\"_blank\">Al Muderis<\/a> in Sydney Australia utilised a high tensile strength titanium implant with high prose plasma sprayed surface as an intramedullary prosthesis that is inserted into the bone residuum of amputees and then connect through an opening in the skin to a robotic limb prosthesis. This allows amputees to mobilise with more comfort and less energy consumption. Al Muderis also published the first series of combining osseointegration prosthesis with Joint replacement enabling below knee amputees with knee arthritis or short residual bone to mobilise without the need of a socket prosthesis.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<\/p><p>\nOn December 7, 2015, two Operation Iraqi Freedom\/Operation Enduring Freedom veterans, Bryant Jacobs and Ed Salau, will be the first in America to get a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous\" title=\"Percutaneous\" rel=\"external_link\" target=\"_blank\">percutaneous<\/a> osseointegrated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthesis<\/a>.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> During the first stage, doctors at Salt Lake Veterans Affairs Hospital will embed a titanium stud in the femur of each patient. About six weeks later, they will go back and attach the docking mechanism for the prosthesis.<\/p>\n<h2><span class=\"mw-headline\" id=\"Mechanism\">Mechanism<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium_biocompatibility\" title=\"Titanium biocompatibility\" rel=\"external_link\" target=\"_blank\">Titanium biocompatibility<\/a><\/div>\n<p>Osseointegration is a dynamic process in which characteristics of the implant (i.e. macrogeometry, surface properties, etc.) play a role in modulating molecular and cellular behavior. While osseointegration has been observed using different materials, it is most often used to describe the reaction of bone tissues to titanium, or titanium coated with calcium phosphate derivatives.<sup id=\"rdp-ebb-cite_ref-Albr_2001_13-0\" class=\"reference\"><a href=\"#cite_note-Albr_2001-13\" rel=\"external_link\">[13]<\/a><\/sup> It was previously thought that titanium implants were retained in bone through the action of mechanical stabilization or interfacial bonding. Alternatively, calcium phosphate coated implants were thought to be stabilized via chemical bonding. It is now known that both calcium phosphate coated implants and titanium implants are stabilized chemically with bone, either through direct contact between calcium and titanium atoms, or by the bonding to a cement line-like layer at the implant\/bone interface.<sup id=\"rdp-ebb-cite_ref-davies_14-0\" class=\"reference\"><a href=\"#cite_note-davies-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-atoms_15-0\" class=\"reference\"><a href=\"#cite_note-atoms-15\" rel=\"external_link\">[15]<\/a><\/sup> While there are some differences (e.g. like the lack of chondrogenic progenitors), osseointegration occurs through the same mechanisms as bone fracture healing.<sup id=\"rdp-ebb-cite_ref-Colnot_2007_16-0\" class=\"reference\"><a href=\"#cite_note-Colnot_2007-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Albrek_osseo_1981_17-0\" class=\"reference\"><a href=\"#cite_note-Albrek_osseo_1981-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technique\">Technique<\/span><\/h2>\n<p>For osseointegrated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental implants<\/a>, metallic, ceramic, and polymeric materials have been used,<sup id=\"rdp-ebb-cite_ref-mosby2002_2-1\" class=\"reference\"><a href=\"#cite_note-mosby2002-2\" rel=\"external_link\">[2]<\/a><\/sup> in particular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a>.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> To be termed osseointegration the connection between the bone and the implant need not be 100 percent, and the essence of osseointegration derives more from the stability of the fixation than the degree of contact in histologic terms. In short it represents a process whereby clinically asymptomatic rigid fixation of alloplastic materials is achieved, and maintained, in bone during functional loading.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup> Implant healing times and initial stability are a function of implant characteristics. For example, implants utilizing a screw-root form design achieve high initial mechanical stability through the action of their screws against the bone. Following placement of the implant, healing typically takes several weeks or months before the implant is fully integrated into the surrounding bone. First evidence of integration occurs after a few weeks, while more robust connection is progressively effected over the next months or years.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> Implants that possess a screw-root form design result in bone resorption followed by interfacial bone remodeling and growth around the implant.<sup id=\"rdp-ebb-cite_ref-Coelho_2014_21-0\" class=\"reference\"><a href=\"#cite_note-Coelho_2014-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p><p>Implants utilizing a plateau-root form design (or screw-root form implants with a wide enough gap between the pitch of the screws) undergo a different mode of peri-implant ossification. Unlike the aforementioned screw-root form implants, plateau-root form implants exhibit de novo bone formation on the implant surface.<sup id=\"rdp-ebb-cite_ref-Berglundh_2003_22-0\" class=\"reference\"><a href=\"#cite_note-Berglundh_2003-22\" rel=\"external_link\">[22]<\/a><\/sup> The type of bone healing exhibited by plateau-root form implants is known as intramembranous-like healing.<sup id=\"rdp-ebb-cite_ref-Coelho_2014_21-1\" class=\"reference\"><a href=\"#cite_note-Coelho_2014-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p><p>Though the osseointegrated interface becomes resistant to external shocks over time, it may be damaged by prolonged adverse stimuli and overload, which may result in implant failure.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> In studies performed using \"Mini dental implants,\" it was noted that the absence of micromotion at the bone-implant interface was necessary to enable proper osseointegration.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> Further, it was noted that there is a critical threshold of micromotion above which a fibrous encapsulation process occurs, rather than osseointegration.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p><p>Other complications may arise even in the absence of external impact. One issue is the growing of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cementum\" title=\"Cementum\" rel=\"external_link\" target=\"_blank\">cement<\/a>.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> In normal cases, the absence of cementum on the implant surface prevents the attachment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Collagen\" title=\"Collagen\" rel=\"external_link\" target=\"_blank\">collagen<\/a> fibers. This is normally the case due to the absence of cementum progenitor cells in the area receiving the implant. However, when such cells are present, cement may form on or around the implant surface, and a functional collagen attachment may attach to it.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Advances_in_materials_engineering:_metal_foams\">Advances in materials engineering: metal foams<\/span><\/h3>\n<p>Since 2005, a number of orthopedic device manufacturers have introduced products that feature <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal_foam\" title=\"Metal foam\" rel=\"external_link\" target=\"_blank\">porous metal construction<\/a>.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> Clinical studies on mammals have shown that porous metals, such as titanium foam, may allow the formation of vascular systems within the porous area.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> For orthopedic uses, metals such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tantalum\" title=\"Tantalum\" rel=\"external_link\" target=\"_blank\">tantalum<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a> are often used, as these metals exhibit high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tensile_strength\" class=\"mw-redirect\" title=\"Tensile strength\" rel=\"external_link\" target=\"_blank\">tensile strength<\/a> and corrosion resistance with excellent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biocompatibility\" title=\"Biocompatibility\" rel=\"external_link\" target=\"_blank\">biocompatibility<\/a>.\n<\/p><p>The process of osseointegration in metal foams is similar to that in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_grafts\" class=\"mw-redirect\" title=\"Bone grafts\" rel=\"external_link\" target=\"_blank\">bone grafts<\/a>. The porous bone-like properties of the metal foam contribute to extensive bone infiltration, allowing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoblast\" title=\"Osteoblast\" rel=\"external_link\" target=\"_blank\">osteoblast<\/a> activity to take place. In addition, the porous structure allows for soft tissue adherence and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascularization\" class=\"mw-redirect\" title=\"Vascularization\" rel=\"external_link\" target=\"_blank\">vascularization<\/a> within the implant. These materials are currently deployed in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">hip replacement<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee_replacement\" title=\"Knee replacement\" rel=\"external_link\" target=\"_blank\">knee replacement<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">dental implant<\/a> surgeries.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Testing_procedures\">Testing procedures<\/span><\/h2>\n<p>There are a number of methods used to gauge the level of osseointegration and the subsequent stability of an implant. One widely used diagnostic procedure is percussion analysis, where a dental instrument is tapped against the implant carrier.<sup id=\"rdp-ebb-cite_ref-:0_33-0\" class=\"reference\"><a href=\"#cite_note-:0-33\" rel=\"external_link\">[33]<\/a><\/sup> The nature of the ringing that results is used as a qualitative measure of the implant\u2019s stability. An integrated implant will elicit a higher pitched \"crystal\" sound, whereas a non-integrated implant will elicit a dull, low-pitched sound.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p><p>Another method is a reverse torque test, in which the implant carrier is unscrewed. If it fails to unscrew under the reverse torque pressure, the implant is stable. If the implant rotates under the pressure it is deemed a failure and removed.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup> This method comes at the risk of fracturing bone that is mid-way in the process of osseointegration.<sup id=\"rdp-ebb-cite_ref-:0_33-1\" class=\"reference\"><a href=\"#cite_note-:0-33\" rel=\"external_link\">[33]<\/a><\/sup> It is also unreliable in determining the osseointegration potential of a bone region, as tests have yielded that a rotating implant can go on to be successfully integrated.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup>\n<\/p><p>A non-invasive and increasingly implemented diagnostic method is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Resonance_frequency_analysis\" title=\"Resonance frequency analysis\" rel=\"external_link\" target=\"_blank\">resonance frequency analysis<\/a> (RFA).<sup id=\"rdp-ebb-cite_ref-:0_33-2\" class=\"reference\"><a href=\"#cite_note-:0-33\" rel=\"external_link\">[33]<\/a><\/sup> A resonance frequency analyzer device prompts vibrations in a small metal rod temporarily attached to the implant. As the rod vibrates, the probe reads its resonance frequency and translates it into an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_stability_quotient\" title=\"Implant stability quotient\" rel=\"external_link\" target=\"_blank\">implant stability quotient<\/a> (ISQ), which ranges from 1\u2013100, with 100 indicating the highest stability state. Values ranging between 57 and 82 are generally considered stable, though each case must be considered independently.<sup id=\"rdp-ebb-cite_ref-:0_33-3\" class=\"reference\"><a href=\"#cite_note-:0-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dental_implant\" title=\"Dental implant\" rel=\"external_link\" target=\"_blank\">Dental implants<\/a> are by far the main field of application<\/li>\n<li>Retention of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Craniofacial_prosthesis\" title=\"Craniofacial prosthesis\" rel=\"external_link\" target=\"_blank\">craniofacial prosthesis<\/a> such as an artificial ear (ear prosthesis), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oral_and_maxillofacial_surgery\" title=\"Oral and maxillofacial surgery\" rel=\"external_link\" target=\"_blank\">maxillofacial<\/a> reconstruction, eye (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Orbital_prosthesis\" class=\"mw-redirect\" title=\"Orbital prosthesis\" rel=\"external_link\" target=\"_blank\">orbital prosthesis<\/a>), or nose (nose prosthesis)<\/li>\n<li>Bone anchored limb prostheses<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup><\/li>\n<li>Bone anchored hearing conduction amplification (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_anchored_hearing_aid\" class=\"mw-redirect\" title=\"Bone anchored hearing aid\" rel=\"external_link\" target=\"_blank\">Bone anchored hearing aid<\/a>)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Eyeborg\" class=\"mw-redirect\" title=\"Eyeborg\" rel=\"external_link\" target=\"_blank\">Eyeborg<\/a> perceive color through sound waves (sound conduction through bone)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee_replacement\" title=\"Knee replacement\" rel=\"external_link\" target=\"_blank\">Knee<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement\" title=\"Joint replacement\" rel=\"external_link\" target=\"_blank\">joint replacement<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div role=\"navigation\" aria-label=\"Portals\" class=\"noprint portal plainlist tright\" style=\"margin:0.5em 0 0.5em 1em;border:solid #aaa 1px\">\n<ul style=\"display:table;box-sizing:border-box;padding:0.1em;max-width:175px;background:#f9f9f9;font-size:85%;line-height:110%;font-style:italic;font-weight:bold\">\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><img alt=\"icon\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/WHO_Rod.svg\/12px-WHO_Rod.svg.png\" width=\"12\" height=\"28\" class=\"noviewer\" \/><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Medicine\" title=\"Portal:Medicine\" rel=\"external_link\" target=\"_blank\">Medicine portal<\/a><\/span><\/li><\/ul><\/div>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Abutment_(dentistry)\" title=\"Abutment (dentistry)\" rel=\"external_link\" target=\"_blank\">Abutment (dentistry)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/British_Society_of_Oral_Implantology\" title=\"British Society of Oral Implantology\" rel=\"external_link\" target=\"_blank\">British Society of Oral Implantology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/European_Association_for_Osseointegration\" title=\"European Association for Osseointegration\" rel=\"external_link\" target=\"_blank\">European Association for Osseointegration<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oral_and_maxillofacial_surgery\" title=\"Oral and maxillofacial surgery\" rel=\"external_link\" target=\"_blank\">Oral and maxillofacial surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteosynthesis\" title=\"Osteosynthesis\" rel=\"external_link\" target=\"_blank\">Osteosynthesis<\/a>, reduction and internal fixation, which may use wires or implants<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Periodontology\" title=\"Periodontology\" rel=\"external_link\" target=\"_blank\">Periodontology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthodontics\" title=\"Prosthodontics\" rel=\"external_link\" target=\"_blank\">Prosthodontics<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes_and_references\">Notes and references<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Miller, Benjamin F.; Keane, Claire B. (1992). <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Miller-Keane_Encyclopedia_%26_Dictionary_of_Medicine,_Nursing,_and_Allied_Health\" title=\"Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health\" rel=\"external_link\" target=\"_blank\">Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, and Allied Health<\/a><\/i>. Philadelphia: Saunders. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-7216-3456-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Miller-Keane+Encyclopedia+%26+Dictionary+of+Medicine%2C+Nursing%2C+and+Allied+Health&rft.place=Philadelphia&rft.pub=Saunders&rft.date=1992&rft.isbn=0-7216-3456-7&rft.aulast=Miller&rft.aufirst=Benjamin+F.&rft.au=Keane%2C+Claire+B.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citing_sources\" title=\"Wikipedia:Citing sources\" rel=\"external_link\" target=\"_blank\"><span title=\"This citation requires a reference to the specific page or range of pages in which the material appears. (August 2010)\">page needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-mosby2002-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-mosby2002_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-mosby2002_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mosby%27s_Medical,_Nursing_%26_Allied_Health_Dictionary\" class=\"mw-redirect\" title=\"Mosby's Medical, Nursing & Allied Health Dictionary\" rel=\"external_link\" target=\"_blank\">Mosby's Medical, Nursing & Allied Health Dictionary<\/a><\/i>. St. Louis: Mosby. 2002. p. 1240. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-323-01430-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Mosby%27s+Medical%2C+Nursing+%26+Allied+Health+Dictionary&rft.place=St.+Louis&rft.pages=1240&rft.pub=Mosby&rft.date=2002&rft.isbn=0-323-01430-5&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Rudy_et_al.-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Rudy_et_al._3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Rudy_et_al._3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Rudy_et_al._3-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Rudy_et_al._3-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Rudy_et_al._3-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Rudy_et_al._3-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rudy, Robert; Levi, Paul A; Bonacci, Fred J; Weisgold, Arnold S; Engler-Hamm, Daniel (2008). \"Intraosseous anchorage of dental prostheses: an early 20th century contribution\". <i>Compend Contin Educ Dent<\/i>. <b>29<\/b> (4): 220\u2013229. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18524206\" target=\"_blank\">18524206<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Compend+Contin+Educ+Dent&rft.atitle=Intraosseous+anchorage+of+dental+prostheses%3A+an+early+20th+century+contribution.&rft.volume=29&rft.issue=4&rft.pages=220-229&rft.date=2008&rft_id=info%3Apmid%2F18524206&rft.aulast=Rudy&rft.aufirst=Robert&rft.au=Levi%2C+Paul+A&rft.au=Bonacci%2C+Fred+J&rft.au=Weisgold%2C+Arnold+S&rft.au=Engler-Hamm%2C+Daniel&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Bothe_et_al.-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Bothe_et_al._4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Bothe_et_al._4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Bothe_et_al._4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Bothe_et_al._4-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bothe, RT; Beaton, KE; Davenport, HA (1940). \"Reaction of bone to multiple metallic implants\". <i>Surg Gynecol Obstet<\/i>. <b>71<\/b>: 598\u2013602.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Surg+Gynecol+Obstet&rft.atitle=Reaction+of+bone+to+multiple+metallic+implants.&rft.volume=71&rft.pages=598-602&rft.date=1940&rft.aulast=Bothe&rft.aufirst=RT&rft.au=Beaton%2C+KE&rft.au=Davenport%2C+HA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Leventhal-5\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Leventhal_5-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Leventhal_5-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Leventhal_5-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Leventhal, Gottlieb (1951). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/eutils.ncbi.nlm.nih.gov\/entrez\/eutils\/elink.fcgi?dbfrom=pubmed&id=14824196&retmode=ref&cmd=prlinks\" target=\"_blank\">\"Titanium, a metal for surgery\"<\/a>. <i>J Bone Joint Surg Am<\/i>. <b>33-A<\/b> (2): 473\u2013474. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/14824196\" target=\"_blank\">14824196<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Am&rft.atitle=Titanium%2C+a+metal+for+surgery&rft.volume=33-A&rft.issue=2&rft.pages=473-474&rft.date=1951&rft_id=info%3Apmid%2F14824196&rft.aulast=Leventhal&rft.aufirst=Gottlieb&rft_id=http%3A%2F%2Feutils.ncbi.nlm.nih.gov%2Fentrez%2Feutils%2Felink.fcgi%3Fdbfrom%3Dpubmed%26id%3D14824196%26retmode%3Dref%26cmd%3Dprlinks&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Br\u00e5nemark PI (September 1983). \"Osseointegration and its experimental background\". <i>The Journal of Prosthetic Dentistry<\/i>. <b>50<\/b> (3): 399\u2013410. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0022-3913%2883%2980101-2\" target=\"_blank\">10.1016\/S0022-3913(83)80101-2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6352924\" target=\"_blank\">6352924<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Prosthetic+Dentistry&rft.atitle=Osseointegration+and+its+experimental+background&rft.volume=50&rft.issue=3&rft.pages=399-410&rft.date=1983-09&rft_id=info%3Adoi%2F10.1016%2FS0022-3913%2883%2980101-2&rft_id=info%3Apmid%2F6352924&rft.au=Br%C3%A5nemark+PI&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Br\u00e5nemark, Per-Ingvar; Zarb, George Albert; Albrektsson, Tomas (1985). <i>Tissue-integrated prostheses: osseointegration in clinical dentistry<\/i>. Chicago: Quintessence. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-86715-129-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Tissue-integrated+prostheses%3A+osseointegration+in+clinical+dentistry&rft.place=Chicago&rft.pub=Quintessence&rft.date=1985&rft.isbn=978-0-86715-129-9&rft.aulast=Br%C3%A5nemark&rft.aufirst=Per-Ingvar&rft.au=Zarb%2C+George+Albert&rft.au=Albrektsson%2C+Tomas&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citing_sources\" title=\"Wikipedia:Citing sources\" rel=\"external_link\" target=\"_blank\"><span title=\"This citation requires a reference to the specific page or range of pages in which the material appears. (August 2010)\">page needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Albrektsson, Tomas; Zarb, George A. (1989). <i>The Branemark osseointegrated implant<\/i>. Chicago: Quintessence Pub. Co. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-86715-208-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Branemark+osseointegrated+implant&rft.place=Chicago&rft.pub=Quintessence+Pub.+Co&rft.date=1989&rft.isbn=978-0-86715-208-1&rft.aulast=Albrektsson&rft.aufirst=Tomas&rft.au=Zarb%2C+George+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citing_sources\" title=\"Wikipedia:Citing sources\" rel=\"external_link\" target=\"_blank\"><span title=\"This citation requires a reference to the specific page or range of pages in which the material appears. (August 2010)\">page needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Beumer, John; Lewis, Steven (1989). <i>The Branemark implant system: clinical and laboratory procedures<\/i>. St. Louis: Ishiyaku EuroAmerica. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-912791-62-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Branemark+implant+system%3A+clinical+and+laboratory+procedures&rft.place=St.+Louis&rft.pub=Ishiyaku+EuroAmerica&rft.date=1989&rft.isbn=0-912791-62-4&rft.aulast=Beumer&rft.aufirst=John&rft.au=Lewis%2C+Steven&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citing_sources\" title=\"Wikipedia:Citing sources\" rel=\"external_link\" target=\"_blank\"><span title=\"This citation requires a reference to the specific page or range of pages in which the material appears. 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Res<\/i>. <b>14<\/b> (3): 251\u2013262. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1034%2Fj.1600-0501.2003.00972.x\" target=\"_blank\">10.1034\/j.1600-0501.2003.00972.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12755774\" target=\"_blank\">12755774<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clin.+Oral+Impl.+Res.&rft.atitle=De+novo+alveolar+bone+formation+adjacent+to+endosseous+implants.&rft.volume=14&rft.issue=3&rft.pages=251-262&rft.date=2003&rft_id=info%3Adoi%2F10.1034%2Fj.1600-0501.2003.00972.x&rft_id=info%3Apmid%2F12755774&rft.aulast=Berglundh&rft.aufirst=T&rft.au=Abrahamsson%2C+I&rft.au=Lang%2C+N&rft.au=Lindhe%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Albrektsson, Tomas; Berglundh, Tord; Lindhe, Jan (2003). \"Osseointegration: Historic Background and Current Concepts\". In Lindhe, Jan; Karring, Thorkild; Lang, Niklaus P. <i>Clinical Periodontology and Implant Dentistry<\/i>. Oxford: Blackwell Munksgaard. p. 816. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-4051-0236-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Osseointegration%3A+Historic+Background+and+Current+Concepts&rft.btitle=Clinical+Periodontology+and+Implant+Dentistry&rft.place=Oxford&rft.pages=816&rft.pub=Blackwell+Munksgaard&rft.date=2003&rft.isbn=1-4051-0236-5&rft.aulast=Albrektsson&rft.aufirst=Tomas&rft.au=Berglundh%2C+Tord&rft.au=Lindhe%2C+Jan&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Isidor F (June 1996). \"Loss of osseointegration caused by occlusal load of oral implants. A clinical and radiographic study in monkeys\". <i>Clinical Oral Implants Research<\/i>. <b>7<\/b> (2): 143\u201352. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1034%2Fj.1600-0501.1996.070208.x\" target=\"_blank\">10.1034\/j.1600-0501.1996.070208.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9002833\" target=\"_blank\">9002833<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Oral+Implants+Research&rft.atitle=Loss+of+osseointegration+caused+by+occlusal+load+of+oral+implants.+A+clinical+and+radiographic+study+in+monkeys&rft.volume=7&rft.issue=2&rft.pages=143-52&rft.date=1996-06&rft_id=info%3Adoi%2F10.1034%2Fj.1600-0501.1996.070208.x&rft_id=info%3Apmid%2F9002833&rft.au=Isidor+F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brunski JB (June 1999). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adr.sagepub.com\/cgi\/pmidlookup?view=long&pmid=11276755\" target=\"_blank\">\"In vivo bone response to biomechanical loading at the bone\/dental-implant interface\"<\/a>. <i>Advances in Dental Research<\/i>. <b>13<\/b>: 99\u2013119. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F08959374990130012301\" target=\"_blank\">10.1177\/08959374990130012301<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11276755\" target=\"_blank\">11276755<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advances+in+Dental+Research&rft.atitle=In+vivo+bone+response+to+biomechanical+loading+at+the+bone%2Fdental-implant+interface&rft.volume=13&rft.pages=99-119&rft.date=1999-06&rft_id=info%3Adoi%2F10.1177%2F08959374990130012301&rft_id=info%3Apmid%2F11276755&rft.au=Brunski+JB&rft_id=http%3A%2F%2Fadr.sagepub.com%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D11276755&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Szmukler-Moncler S, Salama H, Reingewirtz Y, Dubruille JH (1998). \"Timing of loading and effect of micromotion on bone-dental implant interface: review of experimental literature\". <i>Journal of Biomedical Materials Research<\/i>. <b>43<\/b> (2): 192\u2013203. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F%28SICI%291097-4636%28199822%2943%3A2%3C192%3A%3AAID-JBM14%3E3.0.CO%3B2-K\" target=\"_blank\">10.1002\/(SICI)1097-4636(199822)43:2<192::AID-JBM14>3.0.CO;2-K<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9619438\" target=\"_blank\">9619438<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Biomedical+Materials+Research&rft.atitle=Timing+of+loading+and+effect+of+micromotion+on+bone-dental+implant+interface%3A+review+of+experimental+literature&rft.volume=43&rft.issue=2&rft.pages=192-203&rft.date=1998&rft_id=info%3Adoi%2F10.1002%2F%28SICI%291097-4636%28199822%2943%3A2%3C192%3A%3AAID-JBM14%3E3.0.CO%3B2-K&rft_id=info%3Apmid%2F9619438&rft.aulast=Szmukler-Moncler&rft.aufirst=S&rft.au=Salama%2C+H&rft.au=Reingewirtz%2C+Y&rft.au=Dubruille%2C+JH&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pauletto N, Lahiffe BJ, Walton JN (1999). \"Complications associated with excess cement around crowns on osseointegrated implants: a clinical report\". <i>The International Journal of Oral & Maxillofacial Implants<\/i>. <b>14<\/b> (6): 865\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10612925\" target=\"_blank\">10612925<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+International+Journal+of+Oral+%26+Maxillofacial+Implants&rft.atitle=Complications+associated+with+excess+cement+around+crowns+on+osseointegrated+implants%3A+a+clinical+report&rft.volume=14&rft.issue=6&rft.pages=865-8&rft.date=1999&rft_id=info%3Apmid%2F10612925&rft.aulast=Pauletto&rft.aufirst=N&rft.au=Lahiffe%2C+BJ&rft.au=Walton%2C+JN&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Bernard, George W.; Carranza, Ferritin A.; Jovanovic, Sascha A. (1996). \"Biologic Aspects of Dental Implants\". In Carranza, Ferm\u00edn A.; Newman, Michael G. <i>Clinical Periodontology<\/i>. pp. 685\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-7216-6728-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Biologic+Aspects+of+Dental+Implants&rft.btitle=Clinical+Periodontology&rft.pages=685-9&rft.date=1996&rft.isbn=978-0-7216-6728-7&rft.aulast=Bernard&rft.aufirst=George+W.&rft.au=Carranza%2C+Ferritin+A.&rft.au=Jovanovic%2C+Sascha+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Biomet Orthopedics, Regenerex\u00ae Porous Titanium Construct, <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.biomet.com\/orthopedics\/productDetail.cfm?category=2&product=231\" target=\"_blank\">http:\/\/www.biomet.com\/orthopedics\/productDetail.cfm?category=2&product=231<\/a><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Zimmer Orthopedics, Trabeluar Metal Technology, <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.zimmer.com\/ctl?template=CP&op=global&action=1&id=33\" target=\"_blank\">http:\/\/www.zimmer.com\/ctl?template=CP&op=global&action=1&id=33<\/a><\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Zimmer Cancellous-Structured Titanium Porous Coating, <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.zimmer.com\/ctl?op=global&action=1&id=7876&template=MP\" target=\"_blank\">http:\/\/www.zimmer.com\/ctl?op=global&action=1&id=7876&template=MP<\/a><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Osseointegration with Titanium Foam in Rabbit Femur, YouTube: <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.youtube.com\/watch?v=hdscnna5r1Q\" target=\"_blank\">https:\/\/www.youtube.com\/watch?v=hdscnna5r1Q<\/a><\/span>\n<\/li>\n<li id=\"cite_note-:0-33\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_33-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_33-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_33-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_33-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><i>Implant Dentistry - A Rapidly Evolving Practice<\/i>. 2011. pp. 111\u2013126.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Implant+Dentistry+-+A+Rapidly+Evolving+Practice&rft.pages=111-126&rft.date=2011&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\"Current trends to measure implant stability\". <i>Journal of the Indian Prosthodontic Society<\/i>. <b>16<\/b>: 124\u2013130. 2016. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4103%2F0972-4052.176539\" target=\"_blank\">10.4103\/0972-4052.176539<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+Indian+Prosthodontic+Society&rft.atitle=Current+trends+to+measure+implant+stability&rft.volume=16&rft.pages=124-130&rft.date=2016&rft_id=info%3Adoi%2F10.4103%2F0972-4052.176539&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sld.cu\/galerias\/pdf\/sitios\/protesis\/methods_used_to_assess_implant_stability.pdf\" target=\"_blank\">\"Methods Used to Assess Implant Stability: Current Status\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>International Journal of Oral and Maxillofacial Implants<\/i>. <b>22<\/b>: 742\u2013754. 2007.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Oral+and+Maxillofacial+Implants&rft.atitle=Methods+Used+to+Assess+Implant+Stability%3A+Current+Status&rft.volume=22&rft.pages=742-754&rft.date=2007&rft_id=http%3A%2F%2Fwww.sld.cu%2Fgalerias%2Fpdf%2Fsitios%2Fprotesis%2Fmethods_used_to_assess_implant_stability.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ivanoff, C. J.; Sennerby, L.; Lekholm, U. (1997-08-01). \"Reintegration of mobilized titanium implants. An experimental study in rabbit tibia\". <i>International Journal of Oral and Maxillofacial Surgery<\/i>. <b>26<\/b> (4): 310\u2013315. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fs0901-5027%2897%2980878-8\" target=\"_blank\">10.1016\/s0901-5027(97)80878-8<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0901-5027\" target=\"_blank\">0901-5027<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9258729\" target=\"_blank\">9258729<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Oral+and+Maxillofacial+Surgery&rft.atitle=Reintegration+of+mobilized+titanium+implants.+An+experimental+study+in+rabbit+tibia&rft.volume=26&rft.issue=4&rft.pages=310-315&rft.date=1997-08-01&rft.issn=0901-5027&rft_id=info%3Apmid%2F9258729&rft_id=info%3Adoi%2F10.1016%2Fs0901-5027%2897%2980878-8&rft.aulast=Ivanoff&rft.aufirst=C.+J.&rft.au=Sennerby%2C+L.&rft.au=Lekholm%2C+U.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hagberg K, Br\u00e5nemark R (2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rehab.research.va.gov\/jour\/09\/46\/3\/Hagberg.html\" target=\"_blank\">\"One hundred patients treated with osseointegrated transfemoral amputation prostheses--rehabilitation perspective\"<\/a>. <i>Journal of Rehabilitation Research and Development<\/i>. <b>46<\/b> (3): 331\u201344. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19675986\" target=\"_blank\">19675986<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Rehabilitation+Research+and+Development&rft.atitle=One+hundred+patients+treated+with+osseointegrated+transfemoral+amputation+prostheses--rehabilitation+perspective&rft.volume=46&rft.issue=3&rft.pages=331-44&rft.date=2009&rft_id=info%3Apmid%2F19675986&rft.aulast=Hagberg&rft.aufirst=K&rft.au=Br%C3%A5nemark%2C+R&rft_id=http%3A%2F%2Fwww.rehab.research.va.gov%2Fjour%2F09%2F46%2F3%2FHagberg.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div> \n<ul><li>Trabecular Metal Material: The Next Best Thing to BoneTM: <a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.trabecularmetal.zimmerdental.com\/Implant\/imp_home.aspx\" target=\"_blank\">http:\/\/www.trabecularmetal.zimmerdental.com\/Implant\/imp_home.aspx<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation journal\">Zarb GA, Schmitt A (July 1990). \"The longitudinal clinical effectiveness of osseointegrated dental implants: the Toronto Study. Part II: The prosthetic results\". <i>The Journal of Prosthetic Dentistry<\/i>. <b>64<\/b> (1): 53\u201361. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0022-3913%2890%2990153-4\" target=\"_blank\">10.1016\/0022-3913(90)90153-4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2200880\" target=\"_blank\">2200880<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Prosthetic+Dentistry&rft.atitle=The+longitudinal+clinical+effectiveness+of+osseointegrated+dental+implants%3A+the+Toronto+Study.+Part+II%3A+The+prosthetic+results&rft.volume=64&rft.issue=1&rft.pages=53-61&rft.date=1990-07&rft_id=info%3Adoi%2F10.1016%2F0022-3913%2890%2990153-4&rft_id=info%3Apmid%2F2200880&rft.aulast=Zarb&rft.aufirst=GA&rft.au=Schmitt%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Apse P, Zarb GA, Schmitt A, Lewis DW (1991). \"The longitudinal effectiveness of osseointegrated dental implants. The Toronto Study: peri-implant mucosal response\". <i>The International Journal of Periodontics & Restorative Dentistry<\/i>. <b>11<\/b> (2): 94\u2013111. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1718917\" target=\"_blank\">1718917<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+International+Journal+of+Periodontics+%26+Restorative+Dentistry&rft.atitle=The+longitudinal+effectiveness+of+osseointegrated+dental+implants.+The+Toronto+Study%3A+peri-implant+mucosal+response&rft.volume=11&rft.issue=2&rft.pages=94-111&rft.date=1991&rft_id=info%3Apmid%2F1718917&rft.aulast=Apse&rft.aufirst=P&rft.au=Zarb%2C+GA&rft.au=Schmitt%2C+A&rft.au=Lewis%2C+DW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Chaytor DV, Zarb GA, Schmitt A, Lewis DW (1991). \"The longitudinal effectiveness of osseointegrated dental implants. The Toronto Study: bone level changes\". <i>The International Journal of Periodontics & Restorative Dentistry<\/i>. <b>11<\/b> (2): 112\u201325. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1938184\" target=\"_blank\">1938184<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+International+Journal+of+Periodontics+%26+Restorative+Dentistry&rft.atitle=The+longitudinal+effectiveness+of+osseointegrated+dental+implants.+The+Toronto+Study%3A+bone+level+changes&rft.volume=11&rft.issue=2&rft.pages=112-25&rft.date=1991&rft_id=info%3Apmid%2F1938184&rft.aulast=Chaytor&rft.aufirst=DV&rft.au=Zarb%2C+GA&rft.au=Schmitt%2C+A&rft.au=Lewis%2C+DW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Barber AJ, Butterworth CJ, Rogers SN (January 2010). \"Systematic review of primary osseointegrated dental implants in head and neck oncology\". <i>The British Journal of Oral & Maxillofacial Surgery<\/i>. <b>49<\/b> (1): 29\u201336. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.bjoms.2009.12.007\" target=\"_blank\">10.1016\/j.bjoms.2009.12.007<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20079957\" target=\"_blank\">20079957<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+British+Journal+of+Oral+%26+Maxillofacial+Surgery&rft.atitle=Systematic+review+of+primary+osseointegrated+dental+implants+in+head+and+neck+oncology&rft.volume=49&rft.issue=1&rft.pages=29-36&rft.date=2010-01&rft_id=info%3Adoi%2F10.1016%2Fj.bjoms.2009.12.007&rft_id=info%3Apmid%2F20079957&rft.aulast=Barber&rft.aufirst=AJ&rft.au=Butterworth%2C+CJ&rft.au=Rogers%2C+SN&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Hultin M, Gustafsson A, Klinge B (February 2000). \"Long-term evaluation of osseointegrated dental implants in the treatment of partly edentulous patients\". <i>Journal of Clinical Periodontology<\/i>. <b>27<\/b> (2): 128\u201333. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1034%2Fj.1600-051x.2000.027002128.x\" target=\"_blank\">10.1034\/j.1600-051x.2000.027002128.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10703659\" target=\"_blank\">10703659<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Clinical+Periodontology&rft.atitle=Long-term+evaluation+of+osseointegrated+dental+implants+in+the+treatment+of+partly+edentulous+patients&rft.volume=27&rft.issue=2&rft.pages=128-33&rft.date=2000-02&rft_id=info%3Adoi%2F10.1034%2Fj.1600-051x.2000.027002128.x&rft_id=info%3Apmid%2F10703659&rft.aulast=Hultin&rft.aufirst=M&rft.au=Gustafsson%2C+A&rft.au=Klinge%2C+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Oliv\u00e9, Jordi; Aparicio, Carlos (1990). \"The periotest implant as a measure of osseointegrated oral implant stability\". <i>The International Journal of Oral & Maxillofacial Implants<\/i>. <b>5<\/b> (4): 390\u2013400.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+International+Journal+of+Oral+%26+Maxillofacial+Implants&rft.atitle=The+periotest+implant+as+a+measure+of+osseointegrated+oral+implant+stability&rft.volume=5&rft.issue=4&rft.pages=390-400&rft.date=1990&rft.aulast=Oliv%C3%A9&rft.aufirst=Jordi&rft.au=Aparicio%2C+Carlos&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Holmgren EP, Seckinger RJ, Kilgren LM, Mante F (1998). \"Evaluating parameters of osseointegrated dental implants using finite element analysis--a two-dimensional comparative study examining the effects of implant diameter, implant shape, and load direction\". <i>The Journal of Oral Implantology<\/i>. <b>24<\/b> (2): 80\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1563%2F1548-1336%281998%29024%3C0080%3AEPOODI%3E2.3.CO%3B2\" target=\"_blank\">10.1563\/1548-1336(1998)024<0080:EPOODI>2.3.CO;2<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9835834\" target=\"_blank\">9835834<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Oral+Implantology&rft.atitle=Evaluating+parameters+of+osseointegrated+dental+implants+using+finite+element+analysis--a+two-dimensional+comparative+study+examining+the+effects+of+implant+diameter%2C+implant+shape%2C+and+load+direction&rft.volume=24&rft.issue=2&rft.pages=80-8&rft.date=1998&rft_id=info%3Adoi%2F10.1563%2F1548-1336%281998%29024%3C0080%3AEPOODI%3E2.3.CO%3B2&rft_id=info%3Apmid%2F9835834&rft.aulast=Holmgren&rft.aufirst=EP&rft.au=Seckinger%2C+RJ&rft.au=Kilgren%2C+LM&rft.au=Mante%2C+F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AOsseointegration\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nidcr.nih.gov\/grantsandfunding\/see_funding_opportunities_sorted_by\/conceptclearance\/currentcc\/osseointegrated.htm\" target=\"_blank\">Clinical research on osseointegrated dental implants<\/a><\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1263\nCached time: 20181217092740\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.628 seconds\nReal time usage: 0.747 seconds\nPreprocessor visited node count: 2707\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 102323\/2097152 bytes\nTemplate argument size: 2731\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 105126\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.352\/10.000 seconds\nLua memory usage: 5.27 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 647.644 1 -total\n<\/p>\n<pre>60.23% 390.061 1 Template:Reflist\n32.13% 208.084 28 Template:Cite_journal\n16.37% 105.998 10 Template:Cite_book\n 9.69% 62.788 4 Template:Page_needed\n 8.64% 55.949 4 Template:Fix\n 8.49% 55.012 1 Template:Update\n 7.07% 45.782 3 Template:Main_other\n 6.40% 41.447 1 Template:Ambox\n 5.01% 32.416 4 Template:Delink\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1176900-1!canonical and timestamp 20181217092740 and revision id 870831881\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osseointegration\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214705\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.182 seconds\nReal time usage: 0.295 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 284.677 1 - wikipedia:Osseointegration\n100.00% 284.677 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8046-0!*!*!*!*!*!* and timestamp 20181217214705 and revision id 24535\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Osseointegration\">https:\/\/www.limswiki.org\/index.php\/Osseointegration<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","91138ae233fb9e17b5a681bfec9b3c6a_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bc\/Osseointegration_Histology.jpg\/440px-Osseointegration_Histology.jpg"],"91138ae233fb9e17b5a681bfec9b3c6a_timestamp":1545083225,"ecf92fce38dc6c6fbe9e6feac471ffd2_type":"article","ecf92fce38dc6c6fbe9e6feac471ffd2_title":"Magnetic resonance imaging","ecf92fce38dc6c6fbe9e6feac471ffd2_url":"https:\/\/www.limswiki.org\/index.php\/Magnetic_resonance_imaging","ecf92fce38dc6c6fbe9e6feac471ffd2_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tMagnetic resonance imaging\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t\"MRI\" redirects here. For other uses, see MRI (disambiguation).\nMagnetic resonance imagingMedical diagnosticsPlay media Para-sagittal MRI of the head, with aliasing artifacts (nose and forehead appear at the back of the head)Synonymsnuclear magnetic resonance imaging (NMRI), magnetic resonance tomography (MRT)ICD-9-CM88.91MeSHD008279 MedlinePlus003335 \nMagnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body in both health and disease. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves to generate images of the organs in the body. MRI does not involve X-rays or the use of ionizing radiation, which distinguishes it from CT or CAT scans and PET scans. Magnetic resonance imaging is a medical application of nuclear magnetic resonance (NMR). NMR can also be used for imaging in other NMR applications such as NMR spectroscopy.\nWhile the hazards of X-rays are now well-controlled in most medical contexts, an MRI scan may still be seen as a better choice than a CT scan. MRI is widely used in hospitals and clinics for medical diagnosis, staging of disease and follow-up without exposing the body to radiation. However, MRI may often yield different diagnostic information compared with CT. There may be risks and discomfort associated with MRI scans. Compared with CT scans, MRI scans typically take longer and are louder, and they usually need the subject to enter a narrow, confining tube. In addition, people with some medical implants or other non-removable metal inside the body may be unable to undergo an MRI examination safely.\nMRI was originally called NMRI (nuclear magnetic resonance imaging), but the use of 'nuclear' in the acronym was dropped to avoid negative associations with the word.[1] Certain atomic nuclei are able to absorb and emit radio frequency energy when placed in an external magnetic field. In clinical and research MRI, hydrogen atoms are most often used to generate a detectable radio-frequency signal that is received by antennas in close proximity to the anatomy being examined. Hydrogen atoms are naturally abundant in people and other biological organisms, particularly in water and fat. For this reason, most MRI scans essentially map the location of water and fat in the body. Pulses of radio waves excite the nuclear spin energy transition, and magnetic field gradients localize the signal in space. By varying the parameters of the pulse sequence, different contrasts may be generated between tissues based on the relaxation properties of the hydrogen atoms therein.\nSince its development in the 1970s and 1980s, MRI has proven to be a highly versatile imaging technique. While MRI is most prominently used in diagnostic medicine and biomedical research, it also may be used to form images of non-living objects. MRI scans are capable of producing a variety of chemical and physical data, in addition to detailed spatial images. The sustained increase in demand for MRI within health systems has led to concerns about cost effectiveness and overdiagnosis.[2][3]\n\nContents \n\n1 Mechanism \n\n1.1 Construction and physics \n1.2 T1 and T2 \n\n\n2 Diagnostics \n\n2.1 Usage by organ or system \n\n2.1.1 Neuroimaging \n2.1.2 Cardiovascular \n2.1.3 Musculoskeletal \n2.1.4 Liver and gastrointestinal \n2.1.5 Angiography \n\n\n2.2 Contrast agents \n2.3 Sequences \n\n2.3.1 Overview table \n\n\n2.4 Other specialized configurations \n\n2.4.1 Magnetic resonance spectroscopy \n2.4.2 Real-time MRI \n2.4.3 Interventional MRI \n2.4.4 Magnetic resonance guided focused ultrasound \n2.4.5 Multinuclear imaging \n2.4.6 Molecular imaging by MRI \n\n\n\n\n3 Economics \n\n3.1 Clinical MRI installation in a general hospital \n\n\n4 Safety \n\n4.1 Overuse \n\n\n5 Artifacts \n6 Non-medical use \n7 History \n8 See also \n9 References \n10 Further reading \n11 External links \n\n\nMechanism \nConstruction and physics \nMain article: Physics of magnetic resonance imaging\n Schematic of construction of a cylindrical superconducting MR scanner.\nTo perform a study, the person is positioned within an MRI scanner that forms a strong magnetic field around the area to be imaged. In most medical applications, protons (hydrogen atoms) in tissues containing water molecules create a signal that is processed to form an image of the body. First, energy from an oscillating magnetic field temporarily is applied to the patient at the appropriate resonance frequency. The excited hydrogen atoms emit a radio frequency signal, which is measured by a receiving coil. The radio signal may be made to encode position information by varying the main magnetic field using gradient coils. As these coils are rapidly switched on and off they create the characteristic repetitive noise of an MRI scan. The contrast between different tissues is determined by the rate at which excited atoms return to the equilibrium state. Exogenous contrast agents may be given to the person to make the image clearer.[4]\nThe major components of an MRI scanner are the main magnet, which polarizes the sample, the shim coils for correcting shifts in the homogeneity of the main magnetic field, the gradient system which is used to localize the MR signal and the RF system, which excites the sample and detects the resulting NMR signal. The whole system is controlled by one or more computers.\nMRI requires a magnetic field that is both strong and uniform. The field strength of the magnet is measured in teslas \u2013 and while the majority of systems operate at 1.5 T, commercial systems are available between 0.2 and 7 T. Most clinical magnets are superconducting magnets, which require liquid helium. Lower field strengths can be achieved with permanent magnets, which are often used in \"open\" MRI scanners for claustrophobic patients.[5] Recently, MRI has been demonstrated also at ultra-low fields, i.e., in the microtesla-to-millitesla range, where sufficient signal quality is made possible by prepolarization (on the order of 10-100 mT) and by measuring the Larmor precession fields at about 100 microtesla with highly sensitive superconducting quantum interference devices (SQUIDs).[6][7][8]\n\nT1 and T2 \nFurther information: Relaxation (NMR)\n Effects of TR and TE on MR signal\n Examples of T1 weighted, T2 weighted and PD weighted MRI scans\nEach tissue returns to its equilibrium state after excitation by the independent relaxation processes of T1 (spin-lattice; that is, magnetization in the same direction as the static magnetic field) and T2 (spin-spin; transverse to the static magnetic field).\n \nTo create a T1-weighted image, magnetization is allowed to recover before measuring the MR signal by changing the repetition time (TR). This image weighting is useful for assessing the cerebral cortex, identifying fatty tissue, characterizing focal liver lesions and in general for obtaining morphological information, as well as for post-contrast imaging.\n \nTo create a T2-weighted image, magnetization is allowed to decay before measuring the MR signal by changing the echo time (TE). This image weighting is useful for detecting edema and inflammation, revealing white matter lesions and assessing zonal anatomy in the prostate and uterus.\nThe standard display of MRI images is to represent fluid characteristics in black and white images, where different tissues turn out as follows:\n\n\n\nSignal\nT1-weighted\nT2-weighted\n\n\nHigh\n\n\nFat[9][10]\nSubacute hemorrhage[10]\nMelanin[10]\nProtein-rich fluid[10]\nSlowly flowing blood[10]\nParamagnetic substances, such as gadolinium, manganese, copper[10]\nCortical pseudolaminar necrosis[10]\n\n\nMore water content,[9] as in edema, tumor, infarction, inflammation and infection[10]\nExtracellularly located methemoglobin in subacute hemorrhage[10]\n\n\nInter- mediate\n\nGray matter darker than white matter[11]\n\nWhite matter darker than grey matter[11]\n\n\nLow\n\n\nBone[9]\nUrine\nCSF\nAir[9]\nMore water content,[9] as in edema, tumor, infarction, inflammation, infection, hyperacute or chronic hemorrhage[10]\nLow proton density as in calcification[10]\n\n\nBone[9]\nAir[9]\nFat[9]\nLow proton density, as in calcification and fibrosis[10]\nParamagnetic material, such as deoxyhemoglobin, intracelullar methemoglobin, iron, ferritin, hemosiderin, melanin[10]\nProtein-rich fluid[10]\n\nDiagnostics \nUsage by organ or system \n Patient being positioned for MR study of the head and abdomen.\nMRI has a wide range of applications in medical diagnosis and more than 25,000 scanners are estimated to be in use worldwide.[12] MRI affects diagnosis and treatment in many specialties although the effect on improved health outcomes is uncertain.[13]\nMRI is the investigation of choice in the preoperative staging of rectal and prostate cancer and, has a role in the diagnosis, staging, and follow-up of other tumors.[14]\n\nNeuroimaging \nMain article: MRI of brain and brain stem\nSee also: Neuroimaging\n MRI image of white matter tracts\nMRI is the investigative tool of choice for neurological cancers, as it has better resolution than CT and offers better visualization of the posterior cranial fossa, containing the brainstem and the cerebellum. The contrast provided between grey and white matter makes MRI the best choice for many conditions of the central nervous system, including demyelinating diseases, dementia, cerebrovascular disease, infectious diseases, Alzheimer's disease and epilepsy.[15][16][17] Since many images are taken milliseconds apart, it shows how the brain responds to different stimuli, enabling researchers to study both the functional and structural brain abnormalities in psychological disorders.[18] MRI also is used in guided stereotactic surgery and radiosurgery for treatment of intracranial tumors, arteriovenous malformations, and other surgically treatable conditions using a device known as the N-localizer.[19][20][21]\n\nCardiovascular \nMain article: Cardiac magnetic resonance imaging\n MR angiogram in congenital heart disease\nCardiac MRI is complementary to other imaging techniques, such as echocardiography, cardiac CT, and nuclear medicine. Its applications include assessment of myocardial ischemia and viability, cardiomyopathies, myocarditis, iron overload, vascular diseases, and congenital heart disease.[22]\n\nMusculoskeletal \nApplications in the musculoskeletal system include spinal imaging, assessment of joint disease, and soft tissue tumors.[23]\n\nLiver and gastrointestinal \nHepatobiliary MR is used to detect and characterize lesions of the liver, pancreas, and bile ducts. Focal or diffuse disorders of the liver may be evaluated using diffusion-weighted, opposed-phase imaging, and dynamic contrast enhancement sequences. Extracellular contrast agents are used widely in liver MRI and newer hepatobiliary contrast agents also provide the opportunity to perform functional biliary imaging. Anatomical imaging of the bile ducts is achieved by using a heavily T2-weighted sequence in magnetic resonance cholangiopancreatography (MRCP). Functional imaging of the pancreas is performed following administration of secretin. MR enterography provides non-invasive assessment of inflammatory bowel disease and small bowel tumors. MR-colonography may play a role in the detection of large polyps in patients at increased risk of colorectal cancer.[24][25][26][27]\n\nAngiography \n Magnetic resonance angiography\nMain article: Magnetic resonance angiography\nMagnetic resonance angiography (MRA) generates pictures of the arteries to evaluate them for stenosis (abnormal narrowing) or aneurysms (vessel wall dilatations, at risk of rupture). MRA is often used to evaluate the arteries of the neck and brain, the thoracic and abdominal aorta, the renal arteries, and the legs (called a \"run-off\"). A variety of techniques can be used to generate the pictures, such as administration of a paramagnetic contrast agent (gadolinium) or using a technique known as \"flow-related enhancement\" (e.g., 2D and 3D time-of-flight sequences), where most of the signal on an image is due to blood that recently moved into that plane (see also FLASH MRI).\nTechniques involving phase accumulation (known as phase contrast angiography) can also be used to generate flow velocity maps easily and accurately. Magnetic resonance venography (MRV) is a similar procedure that is used to image veins. In this method, the tissue is now excited inferiorly, while the signal is gathered in the plane immediately superior to the excitation plane\u2014thus imaging the venous blood that recently moved from the excited plane.[28]\n\nContrast agents \nMain article: MRI contrast agent\nMRI for imaging anatomical structures or blood flow do not require contrast agents as the varying properties of the tissues or blood provide natural contrasts. However, for more specific types of imaging, exogenous contrast agents may be given intravenously, orally, or intra-articularly.[4] The most commonly used intravenous contrast agents are based on chelates of gadolinium.[29] In general, these agents have proved safer than the iodinated contrast agents used in X-ray radiography or CT. Anaphylactoid reactions are rare, occurring in approx. 0.03\u20130.1%.[30] Of particular interest is the lower incidence of nephrotoxicity, compared with iodinated agents, when given at usual doses\u2014this has made contrast-enhanced MRI scanning an option for patients with renal impairment, who would otherwise not be able to undergo contrast-enhanced CT.[31]\nAlthough gadolinium agents have proved useful for patients with renal impairment, in patients with severe renal failure requiring dialysis there is a risk of a rare but serious illness, nephrogenic systemic fibrosis, which may be linked to the use of certain gadolinium-containing agents. The most frequently linked is gadodiamide, but other agents have been linked too.[32] Although a causal link has not been definitively established, current guidelines in the United States are that dialysis patients should only receive gadolinium agents where essential, and that dialysis should be performed as soon as possible after the scan to remove the agent from the body promptly.[33][34]\nIn Europe, where more gadolinium-containing agents are available, a classification of agents according to potential risks has been released.[35][36] Recently, a new contrast agent named gadoxetate, brand name Eovist (US) or Primovist (EU), was approved for diagnostic use: this has the theoretical benefit of a dual excretion path.[37]\n\nSequences \nMain article: MRI sequences\nAn MRI sequence is a particular setting of radiofrequency pulses and gradients, resulting in a particular image appearance.[38] The T1 and T2 weighting can also be described as MRI sequences.\n\nOverview table \nedit \r\nThis table does not include uncommon and experimental sequences.\n\n\n\n\nGroup\nSequence\nAbbr.\nPhysics\nMain clinical distinctions\nExample\n\n\nSpin echo\nT1 weighted\nT1\nMeasuring spin\u2013lattice relaxation by using a short repetition time (TR) and echo time (TE)\n\n\nLower signal for more water content, [39]as in edema, tumor, infarction, inflammation, infection, hyperacute or chronic hemorrhage [40]\nHigh signal for fat[39][40]\nHigh signal for paramagnetic substances, such as MRI contrast agents[40]\nStandard foundation and comparison for other sequences\n\n\n\n\n\nT2 weighted\nT2\nMeasuring spin\u2013spin relaxation by using long TR and TE times\n\n\nHigher signal for more water content[39]\nLow signal for fat[39]\nLow signal for paramagnetic substances[40]\nStandard foundation and comparison for other sequences\n\n\n\n\n\nProton density weighted\nPD\nLong TR (to reduce T1) and short TE (to minimize T2)[41]\n\nJoint disease and injury.[42]\nHigh signal from meniscus tears[43] (pictured)\n\n\n\n\nGradient echo (GRE)\nSteady-state free precession\nSSFP\nMaintenance of a steady, residual transverse magnetisation over successive cycles.[44]\nCreation of cardiac MRI videos (pictured).[44]\n\n\n\nEffective T2 \r\nor \"T2-star\"\nT2*\nPostexcitation refocused GRE with small flip angle.[45]\nLow signal from hemosiderin deposits (pictured) and hemorrhages.[45]\n\n\n\nInversion recovery\n\nShort tau inversion recovery\nSTIR\nFat suppression by setting an inversion time where the signal of fat is zero[46]\n\nHigh signal in edema, such as in more severe stress fracture[47] Shin splints pictured:\n\n\n\nFluid-attenuated inversion recovery\nFLAIR\nFluid suppression by setting an inversion time that nulls fluids\nHigh signal in lacunar infarction, multiple sclerosis (MS) plaques, subarachnoid haemorrhage and meningitis (pictured).[48]\n\n\n\nDouble inversion recovery\nDIR\nSimultaneous suppression of cerebrospinal fluid and white matter by two inversion times[49]\n\nHigh signal of multiple sclerosis plaques (pictured)[49]\n\n\n\n\nDiffusion weighted (DWI)\nConventional\nDWI\nMeasure of Brownian motion of water molecules[50]\n\nHigh signal within minutes of cerebral infarction (pictured).[51]\n\n\n\n\nApparent diffusion coefficient\nADC\nReduced T2 weighting by taking multiple conventional DWI images with different DWI weighting, and the change corresponds to diffusion[52]\n\nLow signal minutes after cerebral infarction (pictured)[53]\n\n\n\n\nDiffusion tensor\nDTI\nMainly tractography (pictured) by an overall greater Brownian motion of water molecules in the directions of nerve fibers[54]\n\n\nEvaluating white matter deformation by tumors[54]\nReduced fractional anisotropy may indicate dementia[55]\n\n\n\n\nPerfusion weighted (PWI)\n\nDynamic susceptibility contrast\nDSC\nGadolinium contrast is injected, and rapid repeated imaging (generally gradient-echo echo-planar T2 weighted) quantifies susceptibility-induced signal loss[56]\n\nIn cerebral infarction, the infarcted core and the penumbra have decreased perfusion (pictured).[57]\n\n\n\n\nDynamic contrast enhanced\nDCE\nMeasuring shortening of the spin\u2013lattice relaxation (T1) induced by a gadolinium contrast bolus[58]\n\n\nArterial spin labelling\nASL\nMagnetic labeling of arterial blood below the imaging slab, which subsequently enters the region of interest[59] It does not need gadolinium contrast.[60]\n\n\nFunctional MRI (fMRI)\nBlood-oxygen-level dependent imaging\nBOLD\nChanges in oxygen saturation-dependent magnetism of hemoglobin reflects tissue activity.[61]\n\nLocalizing highly active brain areas before surgery[62]\n\n\n\n\nMagnetic resonance angiography (MRA) and venography\nTime-of-flight\nTOF\nBlood entering the imaged area is not yet magnetically saturated, giving it a much higher signal when using short echo time and flow compensation.\n\nDetection of aneurysm, stenosis, or dissection[63]\n\n\n\n\nPhase-contrast magnetic resonance imaging\nPC-MRA\nTwo gradients with equal magnitude, but opposite direction, are used to encode a phase shift, which is proportional to the velocity of spins.[64]\n\nDetection of aneurysm, stenosis, or dissection (pictured)[63]\n\n\r\n(VIPR)\n\n\nSusceptibility-weighted\nSWI\nSensitive for blood and calcium, by a fully flow compensated, long echo, gradient recalled echo (GRE) pulse sequence to exploit magnetic susceptibility differences between tissues\n\nDetecting small amounts of hemorrhage (diffuse axonal injury pictured) or calcium[65]\n\n\n\nOther specialized configurations \nMagnetic resonance spectroscopy \nMain articles: In vivo magnetic resonance spectroscopy and Nuclear magnetic resonance spectroscopy\nMagnetic resonance spectroscopy (MRS) is used to measure the levels of different metabolites in body tissues. The MR signal produces a spectrum of resonances that corresponds to different molecular arrangements of the isotope being \"excited\". This signature is used to diagnose certain metabolic disorders, especially those affecting the brain,[66] and to provide information on tumor metabolism.[67]\nMagnetic resonance spectroscopic imaging (MRSI) combines both spectroscopic and imaging methods to produce spatially localized spectra from within the sample or patient. The spatial resolution is much lower (limited by the available SNR), but the spectra in each voxel contains information about many metabolites. Because the available signal is used to encode spatial and spectral information, MRSI requires high SNR achievable only at higher field strengths (3 T and above).[68] The high procurement and maintenance costs of MRI with extremely high field strengths[69] inhibit their popularity. However, recent compressed sensing-based software algorithms (e.g., SAMV[70]) have been proposed to achieve super-resolution without requiring such high field strengths.\n\nReal-time MRI \nPlay media Real-time MRI of a human heart at a resolution of 50 ms\nMain article: Real-time MRI\nReal-time MRI refers to the continuous imaging of moving objects (such as the heart) in real time. One of the many different strategies developed since the early 2000s is based on radial FLASH MRI, and iterative reconstruction. This gives a temporal resolution of 20\u201330 ms for images with an in-plane resolution of 1.5\u20132.0 mm.[71] Balanced steady-state free precession (bSSFP) imaging has a better image contrast between the blood pool and myocardium than the FLASH MRI, yet it will produce severe banding artifact when the B0 inhomogeneity is strong. Real-time MRI is likely to add important information on diseases of the heart and the joints, and in many cases may make MRI examinations easier and more comfortable for patients, especially for the patients who cannot hold their breathings or who have arrhythmia.[72]\n\nInterventional MRI \nMain article: Interventional magnetic resonance imaging\nThe lack of harmful effects on the patient and the operator make MRI well-suited for interventional radiology, where the images produced by an MRI scanner guide minimally invasive procedures. Such procedures use no ferromagnetic instruments.[citation needed ]\nA specialized growing subset of interventional MRI is intraoperative MRI, in which an MRI is used in surgery. Some specialized MRI systems allow imaging concurrent with the surgical procedure. More typically, the surgical procedure is temporarily interrupted so that MRI can assess the success of the procedure or guide subsequent surgical work.[citation needed ]\n\nMagnetic resonance guided focused ultrasound \nIn guided therapy, high-intensity focused ultrasound (HIFU) beams are focused on a tissue, that are controlled using MR thermal imaging. Due to the high energy at the focus, the temperature rises to above 65 \u00b0C (150 \u00b0F) which completely destroys the tissue. This technology can achieve precise ablation of diseased tissue. MR imaging provides a three-dimensional view of the target tissue, allowing for the precise focusing of ultrasound energy. The MR imaging provides quantitative, real-time, thermal images of the treated area. This allows the physician to ensure that the temperature generated during each cycle of ultrasound energy is sufficient to cause thermal ablation within the desired tissue and if not, to adapt the parameters to ensure effective treatment.[73]\n\nMultinuclear imaging \nHydrogen has the most frequently imaged nucleus in MRI because it is present in biological tissues in great abundance, and because its high gyromagnetic ratio gives a strong signal. However, any nucleus with a net nuclear spin could potentially be imaged with MRI. Such nuclei include helium-3, lithium-7, carbon-13, fluorine-19, oxygen-17, sodium-23, phosphorus-31 and xenon-129. 23Na and 31P are naturally abundant in the body, so can be imaged directly. Gaseous isotopes such as 3He or 129Xe must be hyperpolarized and then inhaled as their nuclear density is too low to yield a useful signal under normal conditions. 17O and 19F can be administered in sufficient quantities in liquid form (e.g. 17O-water) that hyperpolarization is not a necessity.[citation needed ] Using helium or xenon has the advantage of reduced background noise, and therefore increased contrast for the image itself, because these elements are not normally present in biological tissues.[74]\nMoreover, the nucleus of any atom that has a net nuclear spin and that is bonded to a hydrogen atom could potentially be imaged via heteronuclear magnetization transfer MRI that would image the high-gyromagnetic-ratio hydrogen nucleus instead of the low-gyromagnetic-ratio nucleus that is bonded to the hydrogen atom.[75] In principle, hetereonuclear magnetization transfer MRI could be used to detect the presence or absence of specific chemical bonds.[76][77]\nMultinuclear imaging is primarily a research technique at present. However, potential applications include functional imaging and imaging of organs poorly seen on 1H MRI (e.g., lungs and bones) or as alternative contrast agents. Inhaled hyperpolarized 3He can be used to image the distribution of air spaces within the lungs. Injectable solutions containing 13C or stabilized bubbles of hyperpolarized 129Xe have been studied as contrast agents for angiography and perfusion imaging. 31P can potentially provide information on bone density and structure, as well as functional imaging of the brain. Multinuclear imaging holds the potential to chart the distribution of lithium in the human brain, this element finding use as an important drug for those with conditions such as bipolar disorder.[citation needed ]\n\nMolecular imaging by MRI \nMain article: Molecular imaging\nMRI has the advantages of having very high spatial resolution and is very adept at morphological imaging and functional imaging. MRI does have several disadvantages though. First, MRI has a sensitivity of around 10\u22123 mol\/L to 10\u22125 mol\/L, which, compared to other types of imaging, can be very limiting. This problem stems from the fact that the population difference between the nuclear spin states is very small at room temperature. For example, at 1.5 teslas, a typical field strength for clinical MRI, the difference between high and low energy states is approximately 9 molecules per 2 million. Improvements to increase MR sensitivity include increasing magnetic field strength, and hyperpolarization via optical pumping or dynamic nuclear polarization. There are also a variety of signal amplification schemes based on chemical exchange that increase sensitivity.[citation needed ]\nTo achieve molecular imaging of disease biomarkers using MRI, targeted MRI contrast agents with high specificity and high relaxivity (sensitivity) are required. To date, many studies have been devoted to developing targeted-MRI contrast agents to achieve molecular imaging by MRI. Commonly, peptides, antibodies, or small ligands, and small protein domains, such as HER-2 affibodies, have been applied to achieve targeting. To enhance the sensitivity of the contrast agents, these targeting moieties are usually linked to high payload MRI contrast agents or MRI contrast agents with high relaxivities.[78] A new class of gene targeting MR contrast agents (CA) has been introduced to show gene action of unique mRNA and gene transcription factor proteins.[79][80] This new CA can trace cells with unique mRNA, microRNA and virus; tissue response to inflammation in living brains.[81] The MR reports change in gene expression with positive correlation to TaqMan analysis, optical and electron microscopy.[82]\n\nEconomics \nIn the UK, the price of a clinical 1.5-tesla MRI scanner is around \u00a3920,000\/US$1.4 million , with the lifetime maintenance cost broadly similar to the purchase cost.[83] In the Netherlands, the average MRI scanner costs around \u20ac1 million,[84] with a 7-T MRI having been taken in use by the UMC Utrecht in December 2007, costing \u20ac7 million.[85] Construction of MRI suites could cost up to US$500,000 \/\u20ac370.000 or more, depending on project scope. Pre-polarizing MRI (PMRI) systems using resistive electromagnets have shown promise as a low-cost alternative and have specific advantages for joint imaging near metal implants, however they are likely unsuitable for routine whole-body or neuroimaging applications.[86][87]\n\n A 3 tesla clinical MRI scanner.\nMRI scanners have become significant sources of revenue for healthcare providers in the US. This is because of favorable reimbursement rates from insurers and federal government programs. Insurance reimbursement is provided in two components, an equipment charge for the actual performance and operation of the MRI scan and a professional charge for the radiologist's review of the images and\/or data. In the US Northeast, an equipment charge might be $3,500\/\u20ac2,600 and a professional charge might be $350\/\u20ac260,[88] although the actual fees received by the equipment owner and interpreting physician are often significantly less and depend on the rates negotiated with insurance companies or determined by the Medicare fee schedule. For example, an orthopedic surgery group in Illinois billed a charge of $1,116\/\u20ac825 for a knee MRI in 2007, but the Medicare reimbursement in 2007 was only $470.91\/\u20ac350.[89] Many insurance companies require advance approval of an MRI procedure as a condition for coverage.\nIn the US, the Deficit Reduction Act of 2005 significantly reduced reimbursement rates paid by federal insurance programs for the equipment component of many scans, shifting the economic landscape. Many private insurers have followed suit.[citation needed ]\nIn the United States, an MRI of the brain with and without contrast billed to Medicare Part B entails, on average, a technical payment of US$403 \/\u20ac300 and a separate payment to the radiologist of US$93 \/\u20ac70.[90] In France, the cost of an MRI exam is approximately \u20ac150\/US$205 . This covers three basic scans including one with an intravenous contrast agent as well as a consultation with the technician and a written report to the patient's physician.[91] In Japan, the cost of an MRI examination (excluding the cost of contrast material and films) ranges from US$155 \/\u20ac115 to US$180 \/\u20ac133, with an additional radiologist professional fee of US$17 \/\u20ac12.50.[92] In India, the cost of an MRI examination including the fee for the radiologist's opinion comes to around Rs 3000\u20134000 (\u20ac37\u201349\/US$50\u201360 ), excluding the cost of contrast material. In the UK the retail price for an MRI scan privately ranges between \u00a3350 and \u00a3700 (\u20ac405\u2013810).[93]\n\nClinical MRI installation in a general hospital \n\n\t\t\n\t\t\t\n\t\t\t\nControl console\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nBore camera\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nOperator performing a scan\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nTechnical area\n\n\t\t\t\n\t\t\n\nSafety \nMain article: Safety of magnetic resonance imaging\nMRI is in general a safe technique, although injuries may occur as a result of failed safety procedures or human error.[94] Contraindications to MRI include most cochlear implants and cardiac pacemakers, shrapnel, and metallic foreign bodies in the eyes. The safety of MRI during the first trimester of pregnancy is uncertain, but it may be preferable to other options.[95] Since MRI does not use any ionizing radiation, its use is generally favored in preference to CT when either modality could yield the same information.[96] In certain cases, MRI is not preferred as it may be more expensive, time-consuming, and claustrophobia-exacerbating.\nMRI uses powerful magnets and can therefore cause magnetic materials to move at great speeds posing risk. Deaths have occurred.[97] However, as millions of MRIs are performed globally each year.,[98] fatalities are extremely rare.\n\nOveruse \nSee also: Overdiagnosis\nMedical societies issue guidelines for when physicians should use MRI on patients and recommend against overuse. MRI can detect health problems or confirm a diagnosis, but medical societies often recommend that MRI not be the first procedure for creating a plan to diagnose or manage a patient's complaint. A common case is to use MRI to seek a cause of low back pain; the American College of Physicians, for example, recommends against this procedure as unlikely to result in a positive outcome for the patient.[99][100]\n\nArtifacts \n Motion artifact (T1 coronal study of cervical vertebrae).[101]\nMain article: MRI artifact\nAn MRI artifact is a visual artifact, that is, an anomaly during visual representation. Many different artifacts can occur\nduring magnetic resonance imaging (MRI), some affecting the diagnostic quality, while others may be confused with pathology. Artifacts can be classified as patient-related, signal processing-dependent and hardware (machine)-related.[101]\n\nNon-medical use \nMain article: Nuclear magnetic resonance \u00a7 Applications\nMRI is used industrially mainly for routine analysis of chemicals. The nuclear magnetic resonance technique is also used, for example, to measure the ratio between water and fat in foods, monitoring of flow of corrosive fluids in pipes, or to study molecular structures such as catalysts.[102]\n\nHistory \nMain article: History of magnetic resonance imaging\nIn 1971, Paul Lauterbur applied magnetic field gradients in all three dimensions and a back-projection technique to create NMR images. He published the first images of two tubes of water in 1973 in the journal Nature, followed by the picture of a living animal, a clam, and in 1974 by the image of the thoracic cavity of a mouse. Lauterbur called his imaging method zeugmatography, a term which was later replaced by (N)MR imaging.[103] In the late 1970s, physicists Peter Mansfield and Paul Lauterbur, developed MRI-related techniques, like the echo-planar imaging (EPI) technique.[104] Mansfield and Lauterbur were awarded the 2003 Nobel Prize in Physiology or Medicine for their \"discoveries concerning magnetic resonance imaging\".\n\nSee also \n\n\n Medicine portal \n\nEarth's field NMR\nElectron paramagnetic resonance\nHigh-definition fiber tracking\nHistory of neuroimaging\nInternational Society of Magnetic Resonance in Medicine\nJemris\nList of neuroimaging software\nMagnetic immunoassay\nMagnetic particle imaging\nMagnetic resonance elastography\nMagnetic Resonance Imaging (journal)\nMagnetic resonance microscopy\nNobel Prize controversies\nRabi cycle\nRobinson oscillator\nSodium MRI\nVirtopsy\nHigh-resolution computed tomography\nSuper-resolution imaging\nCompressed sensing\n\nReferences \n\n\n^ McRobbie DW, Moore EA, Graves MJ, Prince MR (2007). 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Physical Review B. 12 (9): 3618\u20133634. doi:10.1103\/physrevb.12.3618. \n\n\nFurther reading \n\nRinck PA (ed.). \"The history of MRI\". TRTF\/EMRF. \nEustace SJ, Nelson E (June 2004). \"Whole body magnetic resonance imaging\". BMJ. 328 (7453): 1387\u20138. doi:10.1136\/bmj.328.7453.1387. PMC 421763 . PMID 15191954. \nPykett IL (May 1982). \"NMR imaging in medicine\". Scientific American. 246 (5): 78\u201388. doi:10.1038\/scientificamerican0582-78. PMID 7079720. \nSimon M, Mattson JS (1996). The pioneers of NMR and magnetic resonance in medicine: The story of MRI. Ramat Gan, Israel: Bar-Ilan University Press. ISBN 978-0-9619243-1-7. \nHaacke EM, Brown RF, Thompson M, Venkatesan R (1999). Magnetic resonance imaging: Physical principles and sequence design. New York: J. Wiley & Sons. ISBN 978-0-471-35128-3. \nLee SC, Kim K, Kim J, Lee S, Han Yi J, Kim SW, Ha KS, Cheong C (June 2001). \"One micrometer resolution NMR microscopy\". Journal of Magnetic Resonance. 150 (2): 207\u201313. doi:10.1006\/jmre.2001.2319. PMID 11384182. \nSprawls P (2000). Magnetic Resonance Imaging Principles, Methods, and Techniques. Medical Physics Publishing. ISBN 978-0-944838-97-6. \nMansfield P (1982). NMR Imaging in Biomedicine: Supplement 2 Advances in Magnetic Resonance. Elsevier. ISBN 978-0-323-15406-2. \nFukushima E (1989). NMR in Biomedicine: The Physical Basis. Springer Science & Business Media. ISBN 978-0-88318-609-1. \nBl\u00fcmich B, Kuhn W (1992). Magnetic Resonance Microscopy: Methods and Applications in Materials Science, Agriculture and Biomedicine. Wiley. ISBN 978-3-527-28403-0. \nBl\u00fcmer P (1998). Bl\u00fcmler P, Bl\u00fcmich B, Botto RE, Fukushima E, eds. Spatially Resolved Magnetic Resonance: Methods, Materials, Medicine, Biology, Rheology, Geology, Ecology, Hardware. Wiley-VCH. ISBN 978-3-527-29637-8. \nLiang Z, Lauterbur PC (1999). Principles of Magnetic Resonance Imaging: A Signal Processing Perspective. Wiley. ISBN 978-0-7803-4723-6. \nSchmitt F, Stehling MK, Turner R (1998). Echo-Planar Imaging: Theory, Technique and Application. Springer Berlin Heidelberg. ISBN 978-3-540-63194-1. \nKuperman V (2000). Magnetic Resonance Imaging: Physical Principles and Applications. Academic Press. ISBN 978-0-08-053570-8. \nBl\u00fcmich B (2000). NMR Imaging of Materials. Clarendon Press. ISBN 978-0-19-850683-6. \nJin J (1998). Electromagnetic Analysis and Design in Magnetic Resonance Imaging. CRC Press. ISBN 978-0-8493-9693-9. \nFarhat IA, Belton PS, Webb GA (2007). Magnetic Resonance in Food Science: From Molecules to Man. Royal Society of Chemistry. ISBN 978-0-85404-340-8. \n\nExternal links \n\n\n\nWikimedia Commons has media related to Magnetic resonance imaging.\nLibrary resources about \r\n Magnetic resonance imaging \nResources in your library\n\nRinck PA (ed.). \"MRI: A Peer-Reviewed, Critical Introduction\". European Magnetic Resonance Forum (EMRF)\/The Round Table Foundation (TRTF). \nA Guided Tour of MRI: An introduction for laypeople National High Magnetic Field Laboratory\nThe Basics of MRI. Underlying physics and technical aspects.\nVideo: What to Expect During Your MRI Exam from the Institute for Magnetic Resonance Safety, Education, and Research (IMRSER)\nRoyal Institution Lecture \u2013 MRI: A Window on the Human Body\nA SHORT HISTORY OF MAGNETIC RESONANCE IMAGING FROM A EUROPEAN POINT OF VIEW\n[ permanent dead link ] Animal Imaging Database (AIDB)\nHow MRI works explained simply using diagrams\nReal-time MRI videos: Biomedizinische NMR Forschungs GmbH.\nvteMedical imaging (ICD-9-CM V3 87\u201388, ICD-10-PCS B, CPT 70010\u201379999)X-ray\/\r\nRadiography2DMedical:\nPneumoencephalography\nDental radiography\nSialography\nMyelography\nCXR\nBronchography\nAXR\nKUB\nDXA\/DXR\nUpper gastrointestinal series\/Small-bowel follow-through\/Lower gastrointestinal series\nCholangiography\/Cholecystography\nMammography\nPyelogram\nCystography\nArthrogram\nHysterosalpingography\nSkeletal survey\nAngiography\nAngiocardiography\nAortography\nVenography\nLymphogram\nIndustrial:\nRadiographic testing\nCT scanTechniques:\nGeneral operation of CT\nQuantitative CT\nHigh resolution CT\nX-ray microtomography\nElectron beam tomography\nTargets\nCoronary\nCalcium scan\nCT angiography\nAbdominal and pelvic CT\nVirtual colonoscopy\nCT angiography\nCoronary CT\nPulmonary CT\nHead CT\nThyroid CT\nWhole body imaging\nFull-body CT scan\nOther\nFluoroscopy\nDental panoramic radiography\nX-ray motion analysis\nMRI\nMRI of the brain\nMR neurography\nCardiac MRI\/Cardiac MRI perfusion\nMR angiography\nMR cholangiopancreatography\nBreast MRI\nFunctional MRI\nSequences\nDiffusion MRI\nPerfusion MRI\nTractography\nSynthetic MRI\nUltrasound\nEchocardiography\nDoppler ultrasonography\nDoppler echocardiography\nTTE\nTEE\nTranscranial Doppler\nIntravascular\nGynecologic\nObstetric\nEchoencephalography\nAbdominal ultrasonography\nTransrectal\nBreast ultrasound\nTransscrotal ultrasound\nCarotid ultrasonography\nContrast-enhanced\n3D ultrasound\nEndoscopic ultrasound\nEmergency ultrasound\nFAST\nPre-hospital ultrasound\nDuplex\nRadionuclide2D \/ scintigraphy\nCholescintigraphy\nScintimammography\nVentilation\/perfusion scan\nRadionuclide ventriculography\nRadionuclide angiography\nRadioisotope renography\nSestamibi parathyroid scintigraphy\nRadioactive iodine uptake test\nBone scintigraphy\nImmunoscintigraphy\nDacryoscintigraphy\nDMSA scan\nGastric emptying scan\nFull body:\nOctreotide scan\nGallium 67 scan\nIndium-111 WBC scan\n3D \/ ECTSPECT (gamma ray):\nMyocardial perfusion imaging\nPET (positron):\nBrain PET\nCardiac PET\nPET mammography\nPET-CT\nPET-MRI\nOptical\/Laser\nOptical tomography\nOptical coherence tomography\nConfocal microscopy\nEndomicroscopy\nOrthogonal polarization spectral imaging\nThermography\nnon-contact thermography\ncontact thermography\ndynamic angiothermography\n\nAuthority control \nBNF: cb120656832 (data) \nGND: 4120806-7 \nLCCN: sh85079741 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Magnetic_resonance_imaging\">https:\/\/www.limswiki.org\/index.php\/Magnetic_resonance_imaging<\/a>\n\t\t\t\t\tCategories: Medical and surgical techniquesMedical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:43.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,455 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","ecf92fce38dc6c6fbe9e6feac471ffd2_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Magnetic_resonance_imaging skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Magnetic resonance imaging<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">\"MRI\" redirects here. For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_(disambiguation)\" class=\"mw-disambig\" title=\"MRI (disambiguation)\" rel=\"external_link\" target=\"_blank\">MRI (disambiguation)<\/a>.<\/div>\n\n<p><b>Magnetic resonance imaging<\/b> (<b>MRI<\/b>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_imaging\" title=\"Medical imaging\" rel=\"external_link\" target=\"_blank\">medical imaging<\/a> technique used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiology\" title=\"Radiology\" rel=\"external_link\" target=\"_blank\">radiology<\/a> to form pictures of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anatomy\" title=\"Anatomy\" rel=\"external_link\" target=\"_blank\">anatomy<\/a> and the physiological processes of the body in both health and disease. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physics_of_magnetic_resonance_imaging#MRI_scanner\" title=\"Physics of magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">MRI scanners<\/a> use strong <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_field\" title=\"Magnetic field\" rel=\"external_link\" target=\"_blank\">magnetic fields<\/a>, magnetic field gradients, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radio_wave\" title=\"Radio wave\" rel=\"external_link\" target=\"_blank\">radio waves<\/a> to generate images of the organs in the body. MRI does not involve <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-rays\" class=\"mw-redirect\" title=\"X-rays\" rel=\"external_link\" target=\"_blank\">X-rays<\/a> or the use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ionizing_radiation\" title=\"Ionizing radiation\" rel=\"external_link\" target=\"_blank\">ionizing radiation<\/a>, which distinguishes it from <a href=\"https:\/\/en.wikipedia.org\/wiki\/CT_scan\" title=\"CT scan\" rel=\"external_link\" target=\"_blank\">CT or CAT scans<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/PET_scans\" class=\"mw-redirect\" title=\"PET scans\" rel=\"external_link\" target=\"_blank\">PET scans<\/a>. Magnetic resonance imaging is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance#Medicine\" title=\"Nuclear magnetic resonance\" rel=\"external_link\" target=\"_blank\">medical application<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance\" title=\"Nuclear magnetic resonance\" rel=\"external_link\" target=\"_blank\">nuclear magnetic resonance<\/a> (NMR). NMR can also be used for <i>imaging<\/i> in other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance#Applications\" title=\"Nuclear magnetic resonance\" rel=\"external_link\" target=\"_blank\">NMR applications<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance_spectroscopy\" title=\"Nuclear magnetic resonance spectroscopy\" rel=\"external_link\" target=\"_blank\">NMR spectroscopy<\/a>.\n<\/p><p>While the hazards of X-rays are now well-controlled in most medical contexts, an MRI scan may still be seen as a better choice than a <a href=\"https:\/\/en.wikipedia.org\/wiki\/CT_scan\" title=\"CT scan\" rel=\"external_link\" target=\"_blank\">CT scan<\/a>. MRI is widely used in hospitals and clinics for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_diagnosis\" title=\"Medical diagnosis\" rel=\"external_link\" target=\"_blank\">medical diagnosis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cancer_staging\" title=\"Cancer staging\" rel=\"external_link\" target=\"_blank\">staging<\/a> of disease and follow-up without exposing the body to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ionizing_radiation\" title=\"Ionizing radiation\" rel=\"external_link\" target=\"_blank\">radiation<\/a>. However, MRI may often yield different diagnostic information compared with CT. There may be risks and discomfort associated with MRI scans. Compared with CT scans, MRI scans typically take longer and are louder, and they usually need the subject to enter a narrow, confining tube. In addition, people with some medical implants or other non-removable metal inside the body may be unable to undergo an MRI examination safely.\n<\/p><p>MRI was originally called NMRI (nuclear magnetic resonance imaging), but the use of 'nuclear' in the acronym was dropped to avoid negative associations with the word.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> Certain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atomic_nucleus\" title=\"Atomic nucleus\" rel=\"external_link\" target=\"_blank\">atomic nuclei<\/a> are able to absorb and emit <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radio_frequency\" title=\"Radio frequency\" rel=\"external_link\" target=\"_blank\">radio frequency<\/a> energy when placed in an external <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_field\" title=\"Magnetic field\" rel=\"external_link\" target=\"_blank\">magnetic field<\/a>. In clinical and research MRI, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrogen\" title=\"Hydrogen\" rel=\"external_link\" target=\"_blank\">hydrogen atoms<\/a> are most often used to generate a detectable radio-frequency signal that is received by antennas in close proximity to the anatomy being examined. Hydrogen atoms are naturally abundant in people and other biological organisms, particularly in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Properties_of_water\" title=\"Properties of water\" rel=\"external_link\" target=\"_blank\">water<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lipid\" title=\"Lipid\" rel=\"external_link\" target=\"_blank\">fat<\/a>. For this reason, most MRI scans essentially map the location of water and fat in the body. Pulses of radio waves excite the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin_(physics)\" title=\"Spin (physics)\" rel=\"external_link\" target=\"_blank\">nuclear spin<\/a> energy transition, and magnetic field gradients localize the signal in space. By varying the parameters of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse_sequence\" class=\"mw-redirect\" title=\"Pulse sequence\" rel=\"external_link\" target=\"_blank\">pulse sequence<\/a>, different contrasts may be generated between tissues based on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Relaxation_(NMR)\" title=\"Relaxation (NMR)\" rel=\"external_link\" target=\"_blank\">relaxation<\/a> properties of the hydrogen atoms therein.\n<\/p><p>Since its development in the 1970s and 1980s, MRI has proven to be a highly versatile imaging technique. While MRI is most prominently used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_diagnosis\" title=\"Medical diagnosis\" rel=\"external_link\" target=\"_blank\">diagnostic medicine<\/a> and biomedical research, it also may be used to form images of non-living objects. MRI scans are capable of producing a variety of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion_MRI\" title=\"Diffusion MRI\" rel=\"external_link\" target=\"_blank\">chemical<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Functional_magnetic_resonance_imaging\" title=\"Functional magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">physical<\/a> data, in addition to detailed spatial images. The sustained increase in demand for MRI within <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_system\" title=\"Health system\" rel=\"external_link\" target=\"_blank\">health systems<\/a> has led to concerns about <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cost-effectiveness_analysis\" title=\"Cost-effectiveness analysis\" rel=\"external_link\" target=\"_blank\">cost effectiveness<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Overdiagnosis\" title=\"Overdiagnosis\" rel=\"external_link\" target=\"_blank\">overdiagnosis<\/a>.<sup id=\"rdp-ebb-cite_ref-Smith-Bindman2012_2-0\" class=\"reference\"><a href=\"#cite_note-Smith-Bindman2012-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Mechanism\">Mechanism<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Construction_and_physics\">Construction and physics<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physics_of_magnetic_resonance_imaging\" title=\"Physics of magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">Physics of magnetic resonance imaging<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:332px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mri_scanner_schematic_labelled.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/62\/Mri_scanner_schematic_labelled.svg\/330px-Mri_scanner_schematic_labelled.svg.png\" width=\"330\" height=\"313\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mri_scanner_schematic_labelled.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Schematic of construction of a cylindrical superconducting MR scanner.<\/div><\/div><\/div>\n<p>To perform a study, the person is positioned within an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physics_of_magnetic_resonance_imaging#MRI_scanner\" title=\"Physics of magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">MRI scanner<\/a> that forms a strong <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_field\" title=\"Magnetic field\" rel=\"external_link\" target=\"_blank\">magnetic field<\/a> around the area to be imaged. In most medical applications, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proton\" title=\"Proton\" rel=\"external_link\" target=\"_blank\">protons<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydrogen\" title=\"Hydrogen\" rel=\"external_link\" target=\"_blank\">hydrogen<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atom\" title=\"Atom\" rel=\"external_link\" target=\"_blank\">atoms<\/a>) in tissues containing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Properties_of_water\" title=\"Properties of water\" rel=\"external_link\" target=\"_blank\">water molecules<\/a> create a signal that is processed to form an image of the body. First, energy from an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oscillation\" title=\"Oscillation\" rel=\"external_link\" target=\"_blank\">oscillating<\/a> magnetic field temporarily is applied to the patient at the appropriate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Resonance\" title=\"Resonance\" rel=\"external_link\" target=\"_blank\">resonance<\/a> frequency. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Excited_state\" title=\"Excited state\" rel=\"external_link\" target=\"_blank\">excited<\/a> hydrogen atoms emit a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radio_frequency\" title=\"Radio frequency\" rel=\"external_link\" target=\"_blank\">radio frequency<\/a> signal, which is measured by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiofrequency_coil\" title=\"Radiofrequency coil\" rel=\"external_link\" target=\"_blank\">receiving coil<\/a>. The radio signal may be made to encode position information by varying the main magnetic field using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physics_of_magnetic_resonance_imaging#Gradients\" title=\"Physics of magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">gradient coils<\/a>. As these coils are rapidly switched on and off they create the characteristic repetitive noise of an MRI scan. The contrast between different tissues is determined by the rate at which excited atoms return to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thermodynamic_equilibrium\" title=\"Thermodynamic equilibrium\" rel=\"external_link\" target=\"_blank\">equilibrium state<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Exogeny\" title=\"Exogeny\" rel=\"external_link\" target=\"_blank\">Exogenous<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Contrast_agent\" title=\"Contrast agent\" rel=\"external_link\" target=\"_blank\">contrast agents<\/a> may be given to the person to make the image clearer.<sup id=\"rdp-ebb-cite_ref-McRobbie_4-0\" class=\"reference\"><a href=\"#cite_note-McRobbie-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>The major components of an MRI scanner are the main <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnet\" title=\"Magnet\" rel=\"external_link\" target=\"_blank\">magnet<\/a>, which polarizes the sample, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shim_(magnetism)\" title=\"Shim (magnetism)\" rel=\"external_link\" target=\"_blank\">shim coils<\/a> for correcting shifts in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Homogeneity_(physics)\" title=\"Homogeneity (physics)\" rel=\"external_link\" target=\"_blank\">homogeneity<\/a> of the main magnetic field, the gradient system which is used to localize the MR signal and the RF system, which excites the sample and detects the resulting NMR signal. The whole system is controlled by one or more computers.\n<\/p><p>MRI requires a magnetic field that is both strong and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Homogeneity_(physics)\" title=\"Homogeneity (physics)\" rel=\"external_link\" target=\"_blank\">uniform<\/a>. The field strength of the magnet is measured in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tesla_(unit)\" title=\"Tesla (unit)\" rel=\"external_link\" target=\"_blank\">teslas<\/a> \u2013 and while the majority of systems operate at 1.5 T, commercial systems are available between 0.2 and 7 T. Most clinical magnets are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Superconductivity\" title=\"Superconductivity\" rel=\"external_link\" target=\"_blank\">superconducting<\/a> magnets, which require liquid <a href=\"https:\/\/en.wikipedia.org\/wiki\/Helium\" title=\"Helium\" rel=\"external_link\" target=\"_blank\">helium<\/a>. Lower field strengths can be achieved with permanent magnets, which are often used in \"open\" MRI scanners for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Claustrophobia\" title=\"Claustrophobia\" rel=\"external_link\" target=\"_blank\">claustrophobic<\/a> patients.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Recently, MRI has been demonstrated also at ultra-low fields, i.e., in the microtesla-to-millitesla range, where sufficient signal quality is made possible by prepolarization (on the order of 10-100 mT) and by measuring the Larmor precession fields at about 100 microtesla with highly sensitive superconducting quantum interference devices (<a href=\"https:\/\/en.wikipedia.org\/wiki\/SQUID\" title=\"SQUID\" rel=\"external_link\" target=\"_blank\">SQUID<\/a>s).<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"T1_and_T2\">T1 and T2<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Relaxation_(NMR)\" title=\"Relaxation (NMR)\" rel=\"external_link\" target=\"_blank\">Relaxation (NMR)<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:TR_TE.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4d\/TR_TE.jpg\/220px-TR_TE.jpg\" width=\"220\" height=\"122\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:TR_TE.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Effects of TR and TE on MR signal<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:T1t2PD.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/03\/T1t2PD.jpg\/220px-T1t2PD.jpg\" width=\"220\" height=\"97\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:T1t2PD.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Examples of T1 weighted, T2 weighted and <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_sequence#Proton_density\" title=\"MRI sequence\" rel=\"external_link\" target=\"_blank\">PD<\/a> weighted MRI scans<\/div><\/div><\/div>\n<p>Each tissue returns to its equilibrium state after excitation by the independent relaxation processes of T1 (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin%E2%80%93lattice_relaxation\" title=\"Spin\u2013lattice relaxation\" rel=\"external_link\" target=\"_blank\">spin-lattice<\/a>; that is, magnetization in the same direction as the static magnetic field) and T2 (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin-spin_relaxation_time\" class=\"mw-redirect\" title=\"Spin-spin relaxation time\" rel=\"external_link\" target=\"_blank\">spin-spin<\/a>; transverse to the static magnetic field).\n<span id=\"rdp-ebb-T1-weighted_MRI\"><\/span>\nTo create a T1-weighted image, magnetization is allowed to recover before measuring the MR signal by changing the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Repetition_time\" class=\"mw-redirect\" title=\"Repetition time\" rel=\"external_link\" target=\"_blank\">repetition time<\/a> (TR). This image weighting is useful for assessing the cerebral cortex, identifying fatty tissue, characterizing focal liver lesions and in general for obtaining morphological information, as well as for <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_contrast_agent\" title=\"MRI contrast agent\" rel=\"external_link\" target=\"_blank\">post-contrast<\/a> imaging.\n<span id=\"rdp-ebb-T2-weighted_MRI\"><\/span>\nTo create a T2-weighted image, magnetization is allowed to decay before measuring the MR signal by changing the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Echo_time\" class=\"mw-redirect\" title=\"Echo time\" rel=\"external_link\" target=\"_blank\">echo time<\/a> (TE). This image weighting is useful for detecting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edema\" title=\"Edema\" rel=\"external_link\" target=\"_blank\">edema<\/a> and inflammation, revealing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperintensity\" title=\"Hyperintensity\" rel=\"external_link\" target=\"_blank\">white matter lesions<\/a> and assessing zonal anatomy in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostate\" title=\"Prostate\" rel=\"external_link\" target=\"_blank\">prostate<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uterus\" title=\"Uterus\" rel=\"external_link\" target=\"_blank\">uterus<\/a>.\n<\/p><p>The standard display of MRI images is to represent fluid characteristics in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Black_and_white\" title=\"Black and white\" rel=\"external_link\" target=\"_blank\">black and white<\/a> images, where different tissues turn out as follows:\n<\/p>\n<table class=\"wikitable\" style=\"\">\n<tbody><tr>\n<th>Signal<\/th>\n<th>T1-weighted<\/th>\n<th>T2-weighted\n<\/th><\/tr>\n<tr>\n<td style=\"background: silver\"><b>High<\/b>\n<\/td>\n<td>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fat\" title=\"Fat\" rel=\"external_link\" target=\"_blank\">Fat<\/a><sup id=\"rdp-ebb-cite_ref-wisconsin_9-0\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-johnson2_10-0\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li>Subacute hemorrhage<sup id=\"rdp-ebb-cite_ref-johnson2_10-1\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Melanin\" title=\"Melanin\" rel=\"external_link\" target=\"_blank\">Melanin<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-2\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li>Protein-rich fluid<sup id=\"rdp-ebb-cite_ref-johnson2_10-3\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li>Slowly flowing blood<sup id=\"rdp-ebb-cite_ref-johnson2_10-4\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Paramagnetism\" title=\"Paramagnetism\" rel=\"external_link\" target=\"_blank\">Paramagnetic<\/a> substances, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gadolinium\" title=\"Gadolinium\" rel=\"external_link\" target=\"_blank\">gadolinium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Manganese\" title=\"Manganese\" rel=\"external_link\" target=\"_blank\">manganese<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Copper\" title=\"Copper\" rel=\"external_link\" target=\"_blank\">copper<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-5\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cortical_pseudolaminar_necrosis\" title=\"Cortical pseudolaminar necrosis\" rel=\"external_link\" target=\"_blank\">Cortical pseudolaminar necrosis<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-6\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li><\/ul>\n<\/td>\n<td>\n<ul><li>More water content,<sup id=\"rdp-ebb-cite_ref-wisconsin_9-1\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup> as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edema\" title=\"Edema\" rel=\"external_link\" target=\"_blank\">edema<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumor\" class=\"mw-redirect\" title=\"Tumor\" rel=\"external_link\" target=\"_blank\">tumor<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infarction\" title=\"Infarction\" rel=\"external_link\" target=\"_blank\">infarction<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\" title=\"Inflammation\" rel=\"external_link\" target=\"_blank\">inflammation<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-7\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Extracellular\" title=\"Extracellular\" rel=\"external_link\" target=\"_blank\">Extracellularly<\/a> located <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methemoglobin\" title=\"Methemoglobin\" rel=\"external_link\" target=\"_blank\">methemoglobin<\/a> in subacute hemorrhage<sup id=\"rdp-ebb-cite_ref-johnson2_10-8\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li><\/ul>\n<\/td><\/tr>\n<tr>\n<td style=\"background: grey\"><b>Inter- mediate<\/b>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gray_matter\" class=\"mw-redirect\" title=\"Gray matter\" rel=\"external_link\" target=\"_blank\">Gray matter<\/a> darker than <a href=\"https:\/\/en.wikipedia.org\/wiki\/White_matter\" title=\"White matter\" rel=\"external_link\" target=\"_blank\">white matter<\/a><sup id=\"rdp-ebb-cite_ref-patil_11-0\" class=\"reference\"><a href=\"#cite_note-patil-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/White_matter\" title=\"White matter\" rel=\"external_link\" target=\"_blank\">White matter<\/a> darker than <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grey_matter\" title=\"Grey matter\" rel=\"external_link\" target=\"_blank\">grey matter<\/a><sup id=\"rdp-ebb-cite_ref-patil_11-1\" class=\"reference\"><a href=\"#cite_note-patil-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td style=\"background: black; color:white;\"><b>Low<\/b>\n<\/td>\n<td>\n<ul><li>Bone<sup id=\"rdp-ebb-cite_ref-wisconsin_9-2\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li>Urine<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebrospinal_fluid\" title=\"Cerebrospinal fluid\" rel=\"external_link\" target=\"_blank\">CSF<\/a><\/li>\n<li>Air<sup id=\"rdp-ebb-cite_ref-wisconsin_9-3\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li>More water content,<sup id=\"rdp-ebb-cite_ref-wisconsin_9-4\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup> as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edema\" title=\"Edema\" rel=\"external_link\" target=\"_blank\">edema<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumor\" class=\"mw-redirect\" title=\"Tumor\" rel=\"external_link\" target=\"_blank\">tumor<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infarction\" title=\"Infarction\" rel=\"external_link\" target=\"_blank\">infarction<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\" title=\"Inflammation\" rel=\"external_link\" target=\"_blank\">inflammation<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a>, hyperacute or chronic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemorrhage\" class=\"mw-redirect\" title=\"Hemorrhage\" rel=\"external_link\" target=\"_blank\">hemorrhage<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-9\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li>Low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proton\" title=\"Proton\" rel=\"external_link\" target=\"_blank\">proton<\/a> density as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcification\" title=\"Calcification\" rel=\"external_link\" target=\"_blank\">calcification<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-10\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li><\/ul>\n<\/td>\n<td>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">Bone<\/a><sup id=\"rdp-ebb-cite_ref-wisconsin_9-5\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Air\" class=\"mw-redirect\" title=\"Air\" rel=\"external_link\" target=\"_blank\">Air<\/a><sup id=\"rdp-ebb-cite_ref-wisconsin_9-6\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fat\" title=\"Fat\" rel=\"external_link\" target=\"_blank\">Fat<\/a><sup id=\"rdp-ebb-cite_ref-wisconsin_9-7\" class=\"reference\"><a href=\"#cite_note-wisconsin-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li>\n<li>Low proton density, as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcification\" title=\"Calcification\" rel=\"external_link\" target=\"_blank\">calcification<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibrosis\" title=\"Fibrosis\" rel=\"external_link\" target=\"_blank\">fibrosis<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-11\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Paramagnetism\" title=\"Paramagnetism\" rel=\"external_link\" target=\"_blank\">Paramagnetic<\/a> material, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deoxyhemoglobin\" class=\"mw-redirect\" title=\"Deoxyhemoglobin\" rel=\"external_link\" target=\"_blank\">deoxyhemoglobin<\/a>, intracelullar <a href=\"https:\/\/en.wikipedia.org\/wiki\/Methemoglobin\" title=\"Methemoglobin\" rel=\"external_link\" target=\"_blank\">methemoglobin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron\" title=\"Iron\" rel=\"external_link\" target=\"_blank\">iron<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferritin\" title=\"Ferritin\" rel=\"external_link\" target=\"_blank\">ferritin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemosiderin\" title=\"Hemosiderin\" rel=\"external_link\" target=\"_blank\">hemosiderin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Melanin\" title=\"Melanin\" rel=\"external_link\" target=\"_blank\">melanin<\/a><sup id=\"rdp-ebb-cite_ref-johnson2_10-12\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li>\n<li>Protein-rich fluid<sup id=\"rdp-ebb-cite_ref-johnson2_10-13\" class=\"reference\"><a href=\"#cite_note-johnson2-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li><\/ul>\n<\/td><\/tr><\/tbody><\/table>\n<h2><span class=\"mw-headline\" id=\"Diagnostics\">Diagnostics<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Usage_by_organ_or_system\">Usage by organ or system<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Siemens_Magnetom_Aera_MRI_scanner.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/55\/Siemens_Magnetom_Aera_MRI_scanner.jpg\/220px-Siemens_Magnetom_Aera_MRI_scanner.jpg\" width=\"220\" height=\"136\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Siemens_Magnetom_Aera_MRI_scanner.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Patient being positioned for MR study of the head and abdomen.<\/div><\/div><\/div>\n<p>MRI has a wide range of applications in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_diagnosis\" title=\"Medical diagnosis\" rel=\"external_link\" target=\"_blank\">medical diagnosis<\/a> and more than 25,000 scanners are estimated to be in use worldwide.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> MRI affects diagnosis and treatment in many specialties although the effect on improved health outcomes is uncertain.<sup id=\"rdp-ebb-cite_ref-HollingworthTodd2000_13-0\" class=\"reference\"><a href=\"#cite_note-HollingworthTodd2000-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p><p>MRI is the investigation of choice in the preoperative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cancer_staging\" title=\"Cancer staging\" rel=\"external_link\" target=\"_blank\">staging<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colorectal_cancer\" title=\"Colorectal cancer\" rel=\"external_link\" target=\"_blank\">rectal<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostate_cancer\" title=\"Prostate cancer\" rel=\"external_link\" target=\"_blank\">prostate cancer<\/a> and, has a role in the diagnosis, staging, and follow-up of other tumors.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Neuroimaging\">Neuroimaging<\/span><\/h4>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_of_brain_and_brain_stem\" class=\"mw-redirect\" title=\"MRI of brain and brain stem\" rel=\"external_link\" target=\"_blank\">MRI of brain and brain stem<\/a><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuroimaging\" title=\"Neuroimaging\" rel=\"external_link\" target=\"_blank\">Neuroimaging<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:White_Matter_Connections_Obtained_with_MRI_Tractography.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f2\/White_Matter_Connections_Obtained_with_MRI_Tractography.png\/220px-White_Matter_Connections_Obtained_with_MRI_Tractography.png\" width=\"220\" height=\"303\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:White_Matter_Connections_Obtained_with_MRI_Tractography.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>MRI image of <a href=\"https:\/\/en.wikipedia.org\/wiki\/White_matter\" title=\"White matter\" rel=\"external_link\" target=\"_blank\">white matter<\/a> tracts<\/div><\/div><\/div>\n<p>MRI is the investigative tool of choice for neurological cancers, as it has better resolution than CT and offers better visualization of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Posterior_cranial_fossa\" title=\"Posterior cranial fossa\" rel=\"external_link\" target=\"_blank\">posterior cranial fossa<\/a>, containing the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brainstem\" title=\"Brainstem\" rel=\"external_link\" target=\"_blank\">brainstem<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebellum\" title=\"Cerebellum\" rel=\"external_link\" target=\"_blank\">cerebellum<\/a>. The contrast provided between <a href=\"https:\/\/en.wikipedia.org\/wiki\/Grey_matter\" title=\"Grey matter\" rel=\"external_link\" target=\"_blank\">grey<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/White_matter\" title=\"White matter\" rel=\"external_link\" target=\"_blank\">white matter<\/a> makes MRI the best choice for many conditions of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Central_nervous_system\" title=\"Central nervous system\" rel=\"external_link\" target=\"_blank\">central nervous system<\/a>, including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Demyelinating_disease\" title=\"Demyelinating disease\" rel=\"external_link\" target=\"_blank\">demyelinating diseases<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dementia\" title=\"Dementia\" rel=\"external_link\" target=\"_blank\">dementia<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebrovascular_disease\" title=\"Cerebrovascular disease\" rel=\"external_link\" target=\"_blank\">cerebrovascular disease<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_infections_of_the_central_nervous_system\" title=\"List of infections of the central nervous system\" rel=\"external_link\" target=\"_blank\">infectious diseases<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Alzheimer%27s_disease\" title=\"Alzheimer's disease\" rel=\"external_link\" target=\"_blank\">Alzheimer's disease<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Epilepsy\" title=\"Epilepsy\" rel=\"external_link\" target=\"_blank\">epilepsy<\/a>.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> Since many images are taken milliseconds apart, it shows how the brain responds to different stimuli, enabling researchers to study both the functional and structural brain abnormalities in psychological disorders.<sup id=\"rdp-ebb-cite_ref-Abnormal_Psychology_18-0\" class=\"reference\"><a href=\"#cite_note-Abnormal_Psychology-18\" rel=\"external_link\">[18]<\/a><\/sup> MRI also is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Image_guided_surgery\" class=\"mw-redirect\" title=\"Image guided surgery\" rel=\"external_link\" target=\"_blank\">guided<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereotactic_surgery\" title=\"Stereotactic surgery\" rel=\"external_link\" target=\"_blank\">stereotactic surgery<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiosurgery\" title=\"Radiosurgery\" rel=\"external_link\" target=\"_blank\">radiosurgery<\/a> for treatment of intracranial tumors, arteriovenous malformations, and other surgically treatable conditions using a device known as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/N-localizer\" title=\"N-localizer\" rel=\"external_link\" target=\"_blank\">N-localizer<\/a>.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Cardiovascular\">Cardiovascular<\/span><\/h4>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_magnetic_resonance_imaging\" title=\"Cardiac magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">Cardiac magnetic resonance imaging<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PAPVR.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ad\/PAPVR.gif\/220px-PAPVR.gif\" width=\"220\" height=\"161\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PAPVR.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>MR angiogram in congenital heart disease<\/div><\/div><\/div>\n<p>Cardiac MRI is complementary to other imaging techniques, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Echocardiography\" title=\"Echocardiography\" rel=\"external_link\" target=\"_blank\">echocardiography<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography_of_the_heart\" class=\"mw-redirect\" title=\"Computed tomography of the heart\" rel=\"external_link\" target=\"_blank\">cardiac CT<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_medicine\" title=\"Nuclear medicine\" rel=\"external_link\" target=\"_blank\">nuclear medicine<\/a>. Its applications include assessment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery_disease\" title=\"Coronary artery disease\" rel=\"external_link\" target=\"_blank\">myocardial ischemia and viability<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiomyopathy\" title=\"Cardiomyopathy\" rel=\"external_link\" target=\"_blank\">cardiomyopathies<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myocarditis\" title=\"Myocarditis\" rel=\"external_link\" target=\"_blank\">myocarditis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iron_overload\" title=\"Iron overload\" rel=\"external_link\" target=\"_blank\">iron overload<\/a>, vascular diseases, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Congenital_heart_defect\" title=\"Congenital heart defect\" rel=\"external_link\" target=\"_blank\">congenital heart disease<\/a>.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Musculoskeletal\">Musculoskeletal<\/span><\/h4>\n<p>Applications in the musculoskeletal system include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_cord\" title=\"Spinal cord\" rel=\"external_link\" target=\"_blank\">spinal imaging<\/a>, assessment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint\" title=\"Joint\" rel=\"external_link\" target=\"_blank\">joint<\/a> disease, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Soft_tissue_pathology\" title=\"Soft tissue pathology\" rel=\"external_link\" target=\"_blank\">soft tissue tumors<\/a>.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Liver_and_gastrointestinal\">Liver and gastrointestinal<\/span><\/h4>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatobiliary_system\" class=\"mw-redirect\" title=\"Hepatobiliary system\" rel=\"external_link\" target=\"_blank\">Hepatobiliary<\/a> MR is used to detect and characterize lesions of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liver\" title=\"Liver\" rel=\"external_link\" target=\"_blank\">liver<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pancreas\" title=\"Pancreas\" rel=\"external_link\" target=\"_blank\">pancreas<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bile_duct\" title=\"Bile duct\" rel=\"external_link\" target=\"_blank\">bile ducts<\/a>. Focal or diffuse disorders of the liver may be evaluated using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion_MRI\" title=\"Diffusion MRI\" rel=\"external_link\" target=\"_blank\">diffusion-weighted<\/a>, opposed-phase imaging, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dynamic_Contrast_Enhanced_MRI\" class=\"mw-redirect\" title=\"Dynamic Contrast Enhanced MRI\" rel=\"external_link\" target=\"_blank\">dynamic contrast enhancement<\/a> sequences. Extracellular contrast agents are used widely in liver MRI and newer hepatobiliary contrast agents also provide the opportunity to perform functional biliary imaging. Anatomical imaging of the bile ducts is achieved by using a heavily T2-weighted sequence in magnetic resonance cholangiopancreatography (MRCP). Functional imaging of the pancreas is performed following administration of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Secretin\" title=\"Secretin\" rel=\"external_link\" target=\"_blank\">secretin<\/a>. MR enterography provides non-invasive assessment of inflammatory bowel disease and small bowel tumors. MR-colonography may play a role in the detection of large polyps in patients at increased risk of colorectal cancer.<sup id=\"rdp-ebb-cite_ref-FrydrychowiczLubner2012_24-0\" class=\"reference\"><a href=\"#cite_note-FrydrychowiczLubner2012-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-SandrasegaranLin2010_25-0\" class=\"reference\"><a href=\"#cite_note-SandrasegaranLin2010-25\" rel=\"external_link\">[25]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-MasselliGualdi2012_26-0\" class=\"reference\"><a href=\"#cite_note-MasselliGualdi2012-26\" rel=\"external_link\">[26]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ZijtaBipat2009_27-0\" class=\"reference\"><a href=\"#cite_note-ZijtaBipat2009-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Angiography\">Angiography<\/span><\/h4>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mra1.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/38\/Mra1.jpg\/220px-Mra1.jpg\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mra1.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Magnetic resonance angiography<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_angiography\" title=\"Magnetic resonance angiography\" rel=\"external_link\" target=\"_blank\">Magnetic resonance angiography<\/a><\/div>\n<p>Magnetic resonance <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angiography\" title=\"Angiography\" rel=\"external_link\" target=\"_blank\">angiography<\/a> (MRA) generates pictures of the arteries to evaluate them for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">stenosis<\/a> (abnormal narrowing) or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aneurysm\" title=\"Aneurysm\" rel=\"external_link\" target=\"_blank\">aneurysms<\/a> (vessel wall dilatations, at risk of rupture). MRA is often used to evaluate the arteries of the neck and brain, the thoracic and abdominal aorta, the renal arteries, and the legs (called a \"run-off\"). A variety of techniques can be used to generate the pictures, such as administration of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paramagnetic\" class=\"mw-redirect\" title=\"Paramagnetic\" rel=\"external_link\" target=\"_blank\">paramagnetic<\/a> contrast agent (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Gadolinium\" title=\"Gadolinium\" rel=\"external_link\" target=\"_blank\">gadolinium<\/a>) or using a technique known as \"flow-related enhancement\" (e.g., 2D and 3D time-of-flight sequences), where most of the signal on an image is due to blood that recently moved into that plane (see also <a href=\"https:\/\/en.wikipedia.org\/wiki\/FLASH_MRI\" class=\"mw-redirect\" title=\"FLASH MRI\" rel=\"external_link\" target=\"_blank\">FLASH MRI<\/a>).\n<\/p><p>Techniques involving phase accumulation (known as phase contrast angiography) can also be used to generate flow velocity maps easily and accurately. Magnetic resonance venography (MRV) is a similar procedure that is used to image veins. In this method, the tissue is now excited inferiorly, while the signal is gathered in the plane immediately superior to the excitation plane\u2014thus imaging the venous blood that recently moved from the excited plane.<sup id=\"rdp-ebb-cite_ref-haacke_28-0\" class=\"reference\"><a href=\"#cite_note-haacke-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Contrast_agents\">Contrast agents<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_contrast_agent\" title=\"MRI contrast agent\" rel=\"external_link\" target=\"_blank\">MRI contrast agent<\/a><\/div>\n<p>MRI for imaging anatomical structures or blood flow do not require contrast agents as the varying properties of the tissues or blood provide natural contrasts. However, for more specific types of imaging, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Exogeny\" title=\"Exogeny\" rel=\"external_link\" target=\"_blank\">exogenous<\/a> contrast agents may be given <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy\" title=\"Intravenous therapy\" rel=\"external_link\" target=\"_blank\">intravenously<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oral_administration\" title=\"Oral administration\" rel=\"external_link\" target=\"_blank\">orally<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_injection\" title=\"Joint injection\" rel=\"external_link\" target=\"_blank\">intra-articularly<\/a>.<sup id=\"rdp-ebb-cite_ref-McRobbie_4-1\" class=\"reference\"><a href=\"#cite_note-McRobbie-4\" rel=\"external_link\">[4]<\/a><\/sup> The most commonly used intravenous contrast agents are based on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chelate\" class=\"mw-redirect\" title=\"Chelate\" rel=\"external_link\" target=\"_blank\">chelates<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gadolinium\" title=\"Gadolinium\" rel=\"external_link\" target=\"_blank\">gadolinium<\/a>.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> In general, these agents have proved safer than the iodinated contrast agents used in X-ray radiography or CT. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anaphylaxis\" title=\"Anaphylaxis\" rel=\"external_link\" target=\"_blank\">Anaphylactoid reactions<\/a> are rare, occurring in approx. 0.03\u20130.1%.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup> Of particular interest is the lower incidence of nephrotoxicity, compared with iodinated agents, when given at usual doses\u2014this has made contrast-enhanced MRI scanning an option for patients with renal impairment, who would otherwise not be able to undergo <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiocontrast\" class=\"mw-redirect\" title=\"Radiocontrast\" rel=\"external_link\" target=\"_blank\">contrast-enhanced CT<\/a>.<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup>\n<\/p><p>Although gadolinium agents have proved useful for patients with renal impairment, in patients with severe renal failure requiring dialysis there is a risk of a rare but serious illness, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nephrogenic_systemic_fibrosis\" title=\"Nephrogenic systemic fibrosis\" rel=\"external_link\" target=\"_blank\">nephrogenic systemic fibrosis<\/a>, which may be linked to the use of certain gadolinium-containing agents. The most frequently linked is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gadodiamide\" title=\"Gadodiamide\" rel=\"external_link\" target=\"_blank\">gadodiamide<\/a>, but other agents have been linked too.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> Although a causal link has not been definitively established, current guidelines in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a> are that dialysis patients should only receive gadolinium agents where essential, and that <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dialysis\" title=\"Dialysis\" rel=\"external_link\" target=\"_blank\">dialysis<\/a> should be performed as soon as possible after the scan to remove the agent from the body promptly.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p><p>In Europe, where more gadolinium-containing agents are available, a classification of agents according to potential risks has been released.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup> Recently, a new contrast agent named <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gadoxetic_acid\" title=\"Gadoxetic acid\" rel=\"external_link\" target=\"_blank\">gadoxetate<\/a>, brand name Eovist (US) or Primovist (EU), was approved for diagnostic use: this has the theoretical benefit of a dual excretion path.<sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Sequences\">Sequences<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_sequences\" class=\"mw-redirect\" title=\"MRI sequences\" rel=\"external_link\" target=\"_blank\">MRI sequences<\/a><\/div>\n<p>An <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_sequences\" class=\"mw-redirect\" title=\"MRI sequences\" rel=\"external_link\" target=\"_blank\">MRI sequence<\/a> is a particular setting of radiofrequency pulses and gradients, resulting in a particular image appearance.<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup> The <a href=\"#T1_and_T2\" rel=\"external_link\">T1 and T2<\/a> weighting can also be described as MRI sequences.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Overview_table\">Overview table<\/span><\/h4>\n<p><span class=\"noprint plainlinks\"><\/span><br \/>This table does not include <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_sequences#Uncommon_and_experimental_sequences\" class=\"mw-redirect\" title=\"MRI sequences\" rel=\"external_link\" target=\"_blank\">uncommon and experimental sequences<\/a>.\n<\/p>\n<table class=\"wikitable\" style=\"\">\n\n<tbody><tr>\n<th>Group<\/th>\n<th>Sequence<\/th>\n<th><a href=\"https:\/\/en.wikipedia.org\/wiki\/Abbreviation\" title=\"Abbreviation\" rel=\"external_link\" target=\"_blank\">Abbr.<\/a><\/th>\n<th>Physics<\/th>\n<th>Main clinical distinctions<\/th>\n<th>Example\n<\/th><\/tr>\n<tr>\n<td rowspan=\"3\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin_echo\" title=\"Spin echo\" rel=\"external_link\" target=\"_blank\">Spin echo<\/a><\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging#T1_and_T2\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">T1 weighted<\/a><\/td>\n<td><b>T1<\/b><\/td>\n<td>Measuring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin%E2%80%93lattice_relaxation\" title=\"Spin\u2013lattice relaxation\" rel=\"external_link\" target=\"_blank\">spin\u2013lattice relaxation<\/a> by using a short <a href=\"https:\/\/en.wikipedia.org\/wiki\/Repetition_time\" class=\"mw-redirect\" title=\"Repetition time\" rel=\"external_link\" target=\"_blank\">repetition time<\/a> (TR) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Echo_time\" class=\"mw-redirect\" title=\"Echo time\" rel=\"external_link\" target=\"_blank\">echo time<\/a> (TE)\n<\/td>\n<td>\n<ul><li>Lower signal for more water content, <sup id=\"rdp-ebb-cite_ref-wisconsin2017_39-0\" class=\"reference\"><a href=\"#cite_note-wisconsin2017-39\" rel=\"external_link\">[39]<\/a><\/sup>as in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edema\" title=\"Edema\" rel=\"external_link\" target=\"_blank\">edema<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumor\" class=\"mw-redirect\" title=\"Tumor\" rel=\"external_link\" target=\"_blank\">tumor<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infarction\" title=\"Infarction\" rel=\"external_link\" target=\"_blank\">infarction<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\" title=\"Inflammation\" rel=\"external_link\" target=\"_blank\">inflammation<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infection\" title=\"Infection\" rel=\"external_link\" target=\"_blank\">infection<\/a>, hyperacute or chronic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemorrhage\" class=\"mw-redirect\" title=\"Hemorrhage\" rel=\"external_link\" target=\"_blank\">hemorrhage<\/a> <sup id=\"rdp-ebb-cite_ref-johnson_40-0\" class=\"reference\"><a href=\"#cite_note-johnson-40\" rel=\"external_link\">[40]<\/a><\/sup><\/li>\n<li>High signal for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fat\" title=\"Fat\" rel=\"external_link\" target=\"_blank\">fat<\/a><sup id=\"rdp-ebb-cite_ref-wisconsin2017_39-1\" class=\"reference\"><a href=\"#cite_note-wisconsin2017-39\" rel=\"external_link\">[39]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-johnson_40-1\" class=\"reference\"><a href=\"#cite_note-johnson-40\" rel=\"external_link\">[40]<\/a><\/sup><\/li>\n<li>High signal for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paramagnetism\" title=\"Paramagnetism\" rel=\"external_link\" target=\"_blank\">paramagnetic<\/a> substances, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_contrast_agent\" title=\"MRI contrast agent\" rel=\"external_link\" target=\"_blank\">MRI contrast agents<\/a><sup id=\"rdp-ebb-cite_ref-johnson_40-2\" class=\"reference\"><a href=\"#cite_note-johnson-40\" rel=\"external_link\">[40]<\/a><\/sup><\/li><\/ul>\n<p>Standard foundation and comparison for other sequences\n<\/p>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:T1-weighted-MRI.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"T1-weighted-MRI.png\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/03\/T1-weighted-MRI.png\/100px-T1-weighted-MRI.png\" width=\"100\" height=\"116\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging#T1_and_T2\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">T2 weighted<\/a><\/td>\n<td><b>T2<\/b><\/td>\n<td>Measuring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin%E2%80%93spin_relaxation\" title=\"Spin\u2013spin relaxation\" rel=\"external_link\" target=\"_blank\">spin\u2013spin relaxation<\/a> by using long TR and TE times\n<\/td>\n<td>\n<ul><li>Higher signal for more water content<sup id=\"rdp-ebb-cite_ref-wisconsin2017_39-2\" class=\"reference\"><a href=\"#cite_note-wisconsin2017-39\" rel=\"external_link\">[39]<\/a><\/sup><\/li>\n<li>Low signal for fat<sup id=\"rdp-ebb-cite_ref-wisconsin2017_39-3\" class=\"reference\"><a href=\"#cite_note-wisconsin2017-39\" rel=\"external_link\">[39]<\/a><\/sup><\/li>\n<li>Low signal for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paramagnetism\" title=\"Paramagnetism\" rel=\"external_link\" target=\"_blank\">paramagnetic<\/a> substances<sup id=\"rdp-ebb-cite_ref-johnson_40-3\" class=\"reference\"><a href=\"#cite_note-johnson-40\" rel=\"external_link\">[40]<\/a><\/sup><\/li><\/ul>\n<p>Standard foundation and comparison for other sequences\n<\/p>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Normal_axial_T2-weighted_MR_image_of_the_brain.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Normal axial T2-weighted MR image of the brain.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b7\/Normal_axial_T2-weighted_MR_image_of_the_brain.jpg\/100px-Normal_axial_T2-weighted_MR_image_of_the_brain.jpg\" width=\"100\" height=\"125\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_sequence#PD\" title=\"MRI sequence\" rel=\"external_link\" target=\"_blank\">Proton density weighted<\/a><\/td>\n<td><b>PD<\/b><\/td>\n<td>Long <a href=\"https:\/\/en.wikipedia.org\/wiki\/Repetition_time\" class=\"mw-redirect\" title=\"Repetition time\" rel=\"external_link\" target=\"_blank\">TR<\/a> (to reduce T1) and short <a href=\"https:\/\/en.wikipedia.org\/wiki\/Echo_time\" class=\"mw-redirect\" title=\"Echo time\" rel=\"external_link\" target=\"_blank\">TE<\/a> (to minimize T2)<sup id=\"rdp-ebb-cite_ref-Graham2011_41-0\" class=\"reference\"><a href=\"#cite_note-Graham2011-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthropathy\" title=\"Arthropathy\" rel=\"external_link\" target=\"_blank\">Joint disease<\/a> and injury.<sup id=\"rdp-ebb-cite_ref-Overview_42-0\" class=\"reference\"><a href=\"#cite_note-Overview-42\" rel=\"external_link\">[42]<\/a><\/sup>\n<ul><li>High signal from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tear_of_meniscus\" title=\"Tear of meniscus\" rel=\"external_link\" target=\"_blank\">meniscus tears<\/a><sup id=\"rdp-ebb-cite_ref-LefevreNaouri2016_43-0\" class=\"reference\"><a href=\"#cite_note-LefevreNaouri2016-43\" rel=\"external_link\">[43]<\/a><\/sup> (pictured)<\/li><\/ul>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Proton_density_MRI_of_a_grade_2_medial_meniscal_tear.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Proton density MRI of a grade 2 medial meniscal tear.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Proton_density_MRI_of_a_grade_2_medial_meniscal_tear.jpg\/100px-Proton_density_MRI_of_a_grade_2_medial_meniscal_tear.jpg\" width=\"100\" height=\"101\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td rowspan=\"2\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gradient_echo\" class=\"mw-redirect\" title=\"Gradient echo\" rel=\"external_link\" target=\"_blank\">Gradient echo<\/a> (GRE)<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Steady-state_free_precession_imaging\" title=\"Steady-state free precession imaging\" rel=\"external_link\" target=\"_blank\">Steady-state free precession<\/a><\/td>\n<td><b>SSFP<\/b><\/td>\n<td>Maintenance of a steady, residual transverse magnetisation over successive cycles.<sup id=\"rdp-ebb-cite_ref-Luijkx_44-0\" class=\"reference\"><a href=\"#cite_note-Luijkx-44\" rel=\"external_link\">[44]<\/a><\/sup><\/td>\n<td>Creation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiac_magnetic_resonance_imaging\" title=\"Cardiac magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">cardiac MRI<\/a> videos (pictured).<sup id=\"rdp-ebb-cite_ref-Luijkx_44-1\" class=\"reference\"><a href=\"#cite_note-Luijkx-44\" rel=\"external_link\">[44]<\/a><\/sup><\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Four_chamber_cardiovascular_magnetic_resonance_imaging.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Four chamber cardiovascular magnetic resonance imaging.gif\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/73\/Four_chamber_cardiovascular_magnetic_resonance_imaging.gif\/100px-Four_chamber_cardiovascular_magnetic_resonance_imaging.gif\" width=\"100\" height=\"100\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/T2*-weighted_imaging\" title=\"T2*-weighted imaging\" rel=\"external_link\" target=\"_blank\">Effective T2 <br \/>or \"T2-star\"<\/a><\/td>\n<td><b>T2*<\/b><\/td>\n<td>Postexcitation refocused GRE with small flip angle.<sup id=\"rdp-ebb-cite_ref-ChavhanBabyn2009_45-0\" class=\"reference\"><a href=\"#cite_note-ChavhanBabyn2009-45\" rel=\"external_link\">[45]<\/a><\/sup><\/td>\n<td>Low signal from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemosiderin\" title=\"Hemosiderin\" rel=\"external_link\" target=\"_blank\">hemosiderin<\/a> deposits (pictured) and hemorrhages.<sup id=\"rdp-ebb-cite_ref-ChavhanBabyn2009_45-1\" class=\"reference\"><a href=\"#cite_note-ChavhanBabyn2009-45\" rel=\"external_link\">[45]<\/a><\/sup><\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Effective_T2-weighted_MRI_of_hemosiderin_deposits_after_subarachnoid_hemorrhage.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Effective T2-weighted MRI of hemosiderin deposits after subarachnoid hemorrhage.png\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/Effective_T2-weighted_MRI_of_hemosiderin_deposits_after_subarachnoid_hemorrhage.png\/100px-Effective_T2-weighted_MRI_of_hemosiderin_deposits_after_subarachnoid_hemorrhage.png\" width=\"100\" height=\"100\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td rowspan=\"3\">Inversion recovery\n<\/td>\n<td>Short tau inversion recovery<\/td>\n<td><b>STIR<\/b><\/td>\n<td>Fat suppression by setting an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inversion_time\" class=\"mw-redirect\" title=\"Inversion time\" rel=\"external_link\" target=\"_blank\">inversion time<\/a> where the signal of fat is zero<sup id=\"rdp-ebb-cite_ref-Shorttau_46-0\" class=\"reference\"><a href=\"#cite_note-Shorttau-46\" rel=\"external_link\">[46]<\/a><\/sup>\n<\/td>\n<td>High signal in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Edema\" title=\"Edema\" rel=\"external_link\" target=\"_blank\">edema<\/a>, such as in more severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stress_fracture\" title=\"Stress fracture\" rel=\"external_link\" target=\"_blank\">stress fracture<\/a><sup id=\"rdp-ebb-cite_ref-Stress_47-0\" class=\"reference\"><a href=\"#cite_note-Stress-47\" rel=\"external_link\">[47]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shin_splints\" title=\"Shin splints\" rel=\"external_link\" target=\"_blank\">Shin splints<\/a> pictured:<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Shinsplint-mri_(crop).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Shinsplint-mri (crop).jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Shinsplint-mri_%28crop%29.jpg\/70px-Shinsplint-mri_%28crop%29.jpg\" width=\"70\" height=\"121\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluid-attenuated_inversion_recovery\" title=\"Fluid-attenuated inversion recovery\" rel=\"external_link\" target=\"_blank\">Fluid-attenuated inversion recovery<\/a><\/td>\n<td><b>FLAIR<\/b><\/td>\n<td>Fluid suppression by setting an inversion time that nulls fluids<\/td>\n<td>High signal in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lacunar_stroke\" title=\"Lacunar stroke\" rel=\"external_link\" target=\"_blank\">lacunar infarction<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multiple_sclerosis\" title=\"Multiple sclerosis\" rel=\"external_link\" target=\"_blank\">multiple sclerosis (MS) plaques<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subarachnoid_hemorrhage\" title=\"Subarachnoid hemorrhage\" rel=\"external_link\" target=\"_blank\">subarachnoid haemorrhage<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Meningitis\" title=\"Meningitis\" rel=\"external_link\" target=\"_blank\">meningitis<\/a> (pictured).<sup id=\"rdp-ebb-cite_ref-:0_48-0\" class=\"reference\"><a href=\"#cite_note-:0-48\" rel=\"external_link\">[48]<\/a><\/sup><\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:FLAIR_MRI_of_meningitis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"FLAIR MRI of meningitis.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9b\/FLAIR_MRI_of_meningitis.jpg\/100px-FLAIR_MRI_of_meningitis.jpg\" width=\"100\" height=\"87\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td>Double inversion recovery<\/td>\n<td><b>DIR<\/b><\/td>\n<td>Simultaneous suppression of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebrospinal_fluid\" title=\"Cerebrospinal fluid\" rel=\"external_link\" target=\"_blank\">cerebrospinal fluid<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/White_matter\" title=\"White matter\" rel=\"external_link\" target=\"_blank\">white matter<\/a> by two inversion times<sup id=\"rdp-ebb-cite_ref-muzio_49-0\" class=\"reference\"><a href=\"#cite_note-muzio-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/td>\n<td>High signal of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Multiple_sclerosis\" title=\"Multiple sclerosis\" rel=\"external_link\" target=\"_blank\">multiple sclerosis<\/a> plaques (pictured)<sup id=\"rdp-ebb-cite_ref-muzio_49-1\" class=\"reference\"><a href=\"#cite_note-muzio-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Axial_DIR_MRI_of_a_brain_with_multiple_sclerosis_lesions.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Axial DIR MRI of a brain with multiple sclerosis lesions.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/ce\/Axial_DIR_MRI_of_a_brain_with_multiple_sclerosis_lesions.jpg\/100px-Axial_DIR_MRI_of_a_brain_with_multiple_sclerosis_lesions.jpg\" width=\"100\" height=\"116\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td rowspan=\"3\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion_weighted_imaging\" class=\"mw-redirect\" title=\"Diffusion weighted imaging\" rel=\"external_link\" target=\"_blank\">Diffusion weighted<\/a> (<b>DWI<\/b>)<\/td>\n<td>Conventional<\/td>\n<td><b>DWI<\/b><\/td>\n<td>Measure of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brownian_motion\" title=\"Brownian motion\" rel=\"external_link\" target=\"_blank\">Brownian motion<\/a> of water molecules<sup id=\"rdp-ebb-cite_ref-dwi_50-0\" class=\"reference\"><a href=\"#cite_note-dwi-50\" rel=\"external_link\">[50]<\/a><\/sup>\n<\/td>\n<td>High signal within minutes of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_infarction\" title=\"Cerebral infarction\" rel=\"external_link\" target=\"_blank\">cerebral infarction<\/a> (pictured).<sup id=\"rdp-ebb-cite_ref-IschaemicStroke_51-0\" class=\"reference\"><a href=\"#cite_note-IschaemicStroke-51\" rel=\"external_link\">[51]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cerebral_infarction_after_4_hours_on_DWI_MRI.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Cerebral infarction after 4 hours on DWI MRI.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/Cerebral_infarction_after_4_hours_on_DWI_MRI.jpg\/100px-Cerebral_infarction_after_4_hours_on_DWI_MRI.jpg\" width=\"100\" height=\"108\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Apparent_diffusion_coefficient\" class=\"mw-redirect\" title=\"Apparent diffusion coefficient\" rel=\"external_link\" target=\"_blank\">Apparent diffusion coefficient<\/a><\/td>\n<td><b>ADC<\/b><\/td>\n<td>Reduced T2 weighting by taking multiple conventional DWI images with different DWI weighting, and the change corresponds to diffusion<sup id=\"rdp-ebb-cite_ref-hammer_52-0\" class=\"reference\"><a href=\"#cite_note-hammer-52\" rel=\"external_link\">[52]<\/a><\/sup>\n<\/td>\n<td>Low signal minutes after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_infarction\" title=\"Cerebral infarction\" rel=\"external_link\" target=\"_blank\">cerebral infarction<\/a> (pictured)<sup id=\"rdp-ebb-cite_ref-AnFord2011_53-0\" class=\"reference\"><a href=\"#cite_note-AnFord2011-53\" rel=\"external_link\">[53]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Cerebral_infarction_after_4_hours_on_ADC_MRI.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Cerebral infarction after 4 hours on ADC MRI.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f3\/Cerebral_infarction_after_4_hours_on_ADC_MRI.jpg\/100px-Cerebral_infarction_after_4_hours_on_ADC_MRI.jpg\" width=\"100\" height=\"119\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td>Diffusion tensor<\/td>\n<td><b>DTI<\/b><\/td>\n<td>Mainly <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tractography\" title=\"Tractography\" rel=\"external_link\" target=\"_blank\">tractography<\/a> (pictured) by an overall greater <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brownian_motion\" title=\"Brownian motion\" rel=\"external_link\" target=\"_blank\">Brownian motion<\/a> of water molecules in the directions of nerve fibers<sup id=\"rdp-ebb-cite_ref-radiopaedia-dti_54-0\" class=\"reference\"><a href=\"#cite_note-radiopaedia-dti-54\" rel=\"external_link\">[54]<\/a><\/sup>\n<\/td>\n<td>\n<ul><li>Evaluating white matter deformation by tumors<sup id=\"rdp-ebb-cite_ref-radiopaedia-dti_54-1\" class=\"reference\"><a href=\"#cite_note-radiopaedia-dti-54\" rel=\"external_link\">[54]<\/a><\/sup><\/li>\n<li>Reduced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fractional_anisotropy\" title=\"Fractional anisotropy\" rel=\"external_link\" target=\"_blank\">fractional anisotropy<\/a> may indicate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dementia\" title=\"Dementia\" rel=\"external_link\" target=\"_blank\">dementia<\/a><sup id=\"rdp-ebb-cite_ref-ChuaWen2008_55-0\" class=\"reference\"><a href=\"#cite_note-ChuaWen2008-55\" rel=\"external_link\">[55]<\/a><\/sup><\/li><\/ul>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:White_Matter_Connections_Obtained_with_MRI_Tractography.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"White Matter Connections Obtained with MRI Tractography.png\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f2\/White_Matter_Connections_Obtained_with_MRI_Tractography.png\/100px-White_Matter_Connections_Obtained_with_MRI_Tractography.png\" width=\"100\" height=\"138\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td rowspan=\"3\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Perfusion_MRI\" title=\"Perfusion MRI\" rel=\"external_link\" target=\"_blank\">Perfusion weighted<\/a> (<b>PWI<\/b>)\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dynamic_susceptibility_contrast\" class=\"mw-redirect\" title=\"Dynamic susceptibility contrast\" rel=\"external_link\" target=\"_blank\">Dynamic susceptibility contrast<\/a><\/td>\n<td><b>DSC<\/b><\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gadolinium_contrast\" class=\"mw-redirect\" title=\"Gadolinium contrast\" rel=\"external_link\" target=\"_blank\">Gadolinium contrast<\/a> is injected, and rapid repeated imaging (generally gradient-echo echo-planar <a href=\"https:\/\/en.wikipedia.org\/wiki\/T2_weighted\" class=\"mw-redirect\" title=\"T2 weighted\" rel=\"external_link\" target=\"_blank\">T2 weighted<\/a>) quantifies susceptibility-induced signal loss<sup id=\"rdp-ebb-cite_ref-DSC_56-0\" class=\"reference\"><a href=\"#cite_note-DSC-56\" rel=\"external_link\">[56]<\/a><\/sup>\n<\/td>\n<td rowspan=\"3\">In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_infarction\" title=\"Cerebral infarction\" rel=\"external_link\" target=\"_blank\">cerebral infarction<\/a>, the infarcted core and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Penumbra_(medicine)\" title=\"Penumbra (medicine)\" rel=\"external_link\" target=\"_blank\">penumbra<\/a> have decreased perfusion (pictured).<sup id=\"rdp-ebb-cite_ref-Chen2012_57-0\" class=\"reference\"><a href=\"#cite_note-Chen2012-57\" rel=\"external_link\">[57]<\/a><\/sup>\n<\/td>\n<td rowspan=\"3\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Tmax_by_MRI_perfusion_in_cerebral_artery_occlusion.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Tmax by MRI perfusion in cerebral artery occlusion.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9b\/Tmax_by_MRI_perfusion_in_cerebral_artery_occlusion.jpg\/100px-Tmax_by_MRI_perfusion_in_cerebral_artery_occlusion.jpg\" width=\"100\" height=\"118\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dynamic_contrast_enhanced\" class=\"mw-redirect\" title=\"Dynamic contrast enhanced\" rel=\"external_link\" target=\"_blank\">Dynamic contrast enhanced<\/a><\/td>\n<td><b>DCE<\/b><\/td>\n<td>Measuring shortening of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin%E2%80%93lattice_relaxation\" title=\"Spin\u2013lattice relaxation\" rel=\"external_link\" target=\"_blank\">spin\u2013lattice relaxation<\/a> (T1) induced by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gadolinium_contrast\" class=\"mw-redirect\" title=\"Gadolinium contrast\" rel=\"external_link\" target=\"_blank\">gadolinium contrast<\/a> bolus<sup id=\"rdp-ebb-cite_ref-DCE_58-0\" class=\"reference\"><a href=\"#cite_note-DCE-58\" rel=\"external_link\">[58]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arterial_spin_labelling\" title=\"Arterial spin labelling\" rel=\"external_link\" target=\"_blank\">Arterial spin labelling<\/a><\/td>\n<td><b>ASL<\/b><\/td>\n<td>Magnetic labeling of arterial blood below the imaging slab, which subsequently enters the region of interest<sup id=\"rdp-ebb-cite_ref-UOM_59-0\" class=\"reference\"><a href=\"#cite_note-UOM-59\" rel=\"external_link\">[59]<\/a><\/sup> It does not need gadolinium contrast.<sup id=\"rdp-ebb-cite_ref-ASL_60-0\" class=\"reference\"><a href=\"#cite_note-ASL-60\" rel=\"external_link\">[60]<\/a><\/sup>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Functional_magnetic_resonance_imaging\" title=\"Functional magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">Functional MRI<\/a> (<b>fMRI<\/b>)<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood-oxygen-level_dependent\" class=\"mw-redirect\" title=\"Blood-oxygen-level dependent\" rel=\"external_link\" target=\"_blank\">Blood-oxygen-level dependent<\/a> imaging<\/td>\n<td><b>BOLD<\/b><\/td>\n<td>Changes in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen_saturation_(medicine)\" title=\"Oxygen saturation (medicine)\" rel=\"external_link\" target=\"_blank\">oxygen saturation<\/a>-dependent magnetism of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemoglobin\" title=\"Hemoglobin\" rel=\"external_link\" target=\"_blank\">hemoglobin<\/a> reflects tissue activity.<sup id=\"rdp-ebb-cite_ref-nature1990_61-0\" class=\"reference\"><a href=\"#cite_note-nature1990-61\" rel=\"external_link\">[61]<\/a><\/sup>\n<\/td>\n<td>Localizing highly active brain areas before surgery<sup id=\"rdp-ebb-cite_ref-Fmri_62-0\" class=\"reference\"><a href=\"#cite_note-Fmri-62\" rel=\"external_link\">[62]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:1206_FMRI.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"1206 FMRI.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/1206_FMRI.jpg\/100px-1206_FMRI.jpg\" width=\"100\" height=\"120\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td rowspan=\"2\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_angiography\" title=\"Magnetic resonance angiography\" rel=\"external_link\" target=\"_blank\">Magnetic resonance angiography<\/a> (<b>MRA<\/b>) and venography<\/td>\n<td>Time-of-flight<\/td>\n<td><b>TOF<\/b><\/td>\n<td>Blood entering the imaged area is not yet <a href=\"https:\/\/en.wikipedia.org\/wiki\/Saturation_(magnetic)\" title=\"Saturation (magnetic)\" rel=\"external_link\" target=\"_blank\">magnetically saturated<\/a>, giving it a much higher signal when using short echo time and flow compensation.\n<\/td>\n<td>Detection of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aneurysm\" title=\"Aneurysm\" rel=\"external_link\" target=\"_blank\">aneurysm<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">stenosis<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dissection_(medical)\" title=\"Dissection (medical)\" rel=\"external_link\" target=\"_blank\">dissection<\/a><sup id=\"rdp-ebb-cite_ref-hopkins_63-0\" class=\"reference\"><a href=\"#cite_note-hopkins-63\" rel=\"external_link\">[63]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Mra-mip.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Mra-mip.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/66\/Mra-mip.jpg\/100px-Mra-mip.jpg\" width=\"100\" height=\"117\" \/><\/a>\n<\/td><\/tr>\n<tr>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/Phase_contrast_magnetic_resonance_imaging\" title=\"Phase contrast magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">Phase-contrast magnetic resonance imaging<\/a><\/td>\n<td><b>PC-MRA<\/b><\/td>\n<td>Two gradients with equal magnitude, but opposite direction, are used to encode a phase shift, which is proportional to the velocity of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin_(physics)\" title=\"Spin (physics)\" rel=\"external_link\" target=\"_blank\">spins<\/a>.<sup id=\"rdp-ebb-cite_ref-64\" class=\"reference\"><a href=\"#cite_note-64\" rel=\"external_link\">[64]<\/a><\/sup>\n<\/td>\n<td>Detection of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aneurysm\" title=\"Aneurysm\" rel=\"external_link\" target=\"_blank\">aneurysm<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">stenosis<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dissection_(medical)\" title=\"Dissection (medical)\" rel=\"external_link\" target=\"_blank\">dissection<\/a> (pictured)<sup id=\"rdp-ebb-cite_ref-hopkins_63-1\" class=\"reference\"><a href=\"#cite_note-hopkins-63\" rel=\"external_link\">[63]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vastly_undersampled_Isotropic_Projection_Reconstruction_(VIPR)_Phase_Contrast_(PC)_sequence_MRI_of_arterial_dissections.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Vastly undersampled Isotropic Projection Reconstruction (VIPR) Phase Contrast (PC) sequence MRI of arterial dissections.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/26\/Vastly_undersampled_Isotropic_Projection_Reconstruction_%28VIPR%29_Phase_Contrast_%28PC%29_sequence_MRI_of_arterial_dissections.jpg\/100px-Vastly_undersampled_Isotropic_Projection_Reconstruction_%28VIPR%29_Phase_Contrast_%28PC%29_sequence_MRI_of_arterial_dissections.jpg\" width=\"100\" height=\"95\" \/><\/a><br \/>(<a href=\"https:\/\/en.wikipedia.org\/wiki\/Vastly_undersampled_Isotropic_Projection_Reconstruction\" class=\"mw-redirect\" title=\"Vastly undersampled Isotropic Projection Reconstruction\" rel=\"external_link\" target=\"_blank\">VIPR<\/a>)\n<\/td><\/tr>\n<tr>\n<td colspan=\"2\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Susceptibility_weighted_imaging\" title=\"Susceptibility weighted imaging\" rel=\"external_link\" target=\"_blank\">Susceptibility-weighted<\/a><\/td>\n<td><b>SWI<\/b><\/td>\n<td>Sensitive for blood and calcium, by a fully flow compensated, long echo, gradient recalled echo (GRE) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse_sequence\" class=\"mw-redirect\" title=\"Pulse sequence\" rel=\"external_link\" target=\"_blank\">pulse sequence<\/a> to exploit <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_susceptibility\" title=\"Magnetic susceptibility\" rel=\"external_link\" target=\"_blank\">magnetic susceptibility<\/a> differences between tissues\n<\/td>\n<td>Detecting small amounts of hemorrhage (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffuse_axonal_injury\" title=\"Diffuse axonal injury\" rel=\"external_link\" target=\"_blank\">diffuse axonal injury<\/a> pictured) or calcium<sup id=\"rdp-ebb-cite_ref-swi_65-0\" class=\"reference\"><a href=\"#cite_note-swi-65\" rel=\"external_link\">[65]<\/a><\/sup>\n<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Susceptibility_weighted_imaging_(SWI)_in_diffuse_axonal_injury.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Susceptibility weighted imaging (SWI) in diffuse axonal injury.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a5\/Susceptibility_weighted_imaging_%28SWI%29_in_diffuse_axonal_injury.jpg\/100px-Susceptibility_weighted_imaging_%28SWI%29_in_diffuse_axonal_injury.jpg\" width=\"100\" height=\"116\" \/><\/a>\n<\/td><\/tr><\/tbody><\/table>\n<h3><span class=\"mw-headline\" id=\"Other_specialized_configurations\">Other specialized configurations<\/span><\/h3>\n<h4><span class=\"mw-headline\" id=\"Magnetic_resonance_spectroscopy\">Magnetic resonance spectroscopy<\/span><\/h4>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main articles: <a href=\"https:\/\/en.wikipedia.org\/wiki\/In_vivo_magnetic_resonance_spectroscopy\" title=\"In vivo magnetic resonance spectroscopy\" rel=\"external_link\" target=\"_blank\">In vivo magnetic resonance spectroscopy<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance_spectroscopy\" title=\"Nuclear magnetic resonance spectroscopy\" rel=\"external_link\" target=\"_blank\">Nuclear magnetic resonance spectroscopy<\/a><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/In_vivo_magnetic_resonance_spectroscopy\" title=\"In vivo magnetic resonance spectroscopy\" rel=\"external_link\" target=\"_blank\">Magnetic resonance spectroscopy<\/a> (MRS) is used to measure the levels of different <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolites\" class=\"mw-redirect\" title=\"Metabolites\" rel=\"external_link\" target=\"_blank\">metabolites<\/a> in body tissues. The MR signal produces a spectrum of resonances that corresponds to different molecular arrangements of the isotope being \"excited\". This signature is used to diagnose certain metabolic disorders, especially those affecting the brain,<sup id=\"rdp-ebb-cite_ref-66\" class=\"reference\"><a href=\"#cite_note-66\" rel=\"external_link\">[66]<\/a><\/sup> and to provide information on tumor <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolism\" title=\"Metabolism\" rel=\"external_link\" target=\"_blank\">metabolism<\/a>.<sup id=\"rdp-ebb-cite_ref-67\" class=\"reference\"><a href=\"#cite_note-67\" rel=\"external_link\">[67]<\/a><\/sup>\n<\/p><p>Magnetic resonance spectroscopic imaging (MRSI) combines both spectroscopic and imaging methods to produce spatially localized spectra from within the sample or patient. The spatial resolution is much lower (limited by the available <a href=\"https:\/\/en.wikipedia.org\/wiki\/Signal-to-noise_ratio\" title=\"Signal-to-noise ratio\" rel=\"external_link\" target=\"_blank\">SNR<\/a>), but the spectra in each voxel contains information about many metabolites. Because the available signal is used to encode spatial and spectral information, MRSI requires high SNR achievable only at higher field strengths (3 T and above).<sup id=\"rdp-ebb-cite_ref-DW_Al._2018_68-0\" class=\"reference\"><a href=\"#cite_note-DW_Al._2018-68\" rel=\"external_link\">[68]<\/a><\/sup> The high procurement and maintenance costs of MRI with extremely high field strengths<sup id=\"rdp-ebb-cite_ref-69\" class=\"reference\"><a href=\"#cite_note-69\" rel=\"external_link\">[69]<\/a><\/sup> inhibit their popularity. However, recent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compressed_sensing\" title=\"Compressed sensing\" rel=\"external_link\" target=\"_blank\">compressed sensing<\/a>-based software algorithms (<i>e.g.<\/i>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/SAMV_(algorithm)\" title=\"SAMV (algorithm)\" rel=\"external_link\" target=\"_blank\">SAMV<\/a><sup id=\"rdp-ebb-cite_ref-AbeidaZhang_70-0\" class=\"reference\"><a href=\"#cite_note-AbeidaZhang-70\" rel=\"external_link\">[70]<\/a><\/sup>) have been proposed to achieve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Super-resolution_imaging\" title=\"Super-resolution imaging\" rel=\"external_link\" target=\"_blank\">super-resolution<\/a> without requiring such high field strengths.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Real-time_MRI\">Real-time MRI<\/span><\/h4>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><div id=\"rdp-ebb-mwe_player_2\" class=\"PopUpMediaTransform\" style=\"width:220px;\" videopayload=\"<div class="mediaContainer" style="width:384px"><video id="mwe_player_3" poster="\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/384px--Real-time_MRI_-_Thorax.ogv.jpg" controls="" preload="none" autoplay="" style="width:384px;height:384px" class="kskin" data-durationhint="15.75" data-startoffset="0" data-mwtitle="Real-time_MRI_-_Thorax.ogv" data-mwprovider="wikimediacommons"><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/d\/dd\/Real-time_MRI_-_Thorax.ogv" type="video\/ogg; codecs=&quot;theora&quot;" data-title="Original Ogg file, 384 \u00d7 384 (819 kbps)" data-shorttitle="Ogg source" data-width="384" data-height="384" data-bandwidth="818502" data-framerate="20"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/Real-time_MRI_-_Thorax.ogv.120p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Lowest bandwidth VP9 (120P)" data-shorttitle="VP9 120P" data-transcodekey="120p.vp9.webm" data-width="120" data-height="120" data-bandwidth="63112" data-framerate="20"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/Real-time_MRI_-_Thorax.ogv.160p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Low bandwidth WebM (160P)" data-shorttitle="WebM 160P" data-transcodekey="160p.webm" data-width="160" data-height="160" data-bandwidth="126952" data-framerate="20"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/Real-time_MRI_-_Thorax.ogv.180p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Low bandwidth VP9 (180P)" data-shorttitle="VP9 180P" data-transcodekey="180p.vp9.webm" data-width="180" data-height="180" data-bandwidth="102768" data-framerate="20"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/Real-time_MRI_-_Thorax.ogv.240p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="Small VP9 (240P)" data-shorttitle="VP9 240P" data-transcodekey="240p.vp9.webm" data-width="240" data-height="240" data-bandwidth="132512" data-framerate="20"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/Real-time_MRI_-_Thorax.ogv.240p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="Small WebM (240P)" data-shorttitle="WebM 240P" data-transcodekey="240p.webm" data-width="240" data-height="240" data-bandwidth="253424" data-framerate="20"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/Real-time_MRI_-_Thorax.ogv.360p.vp9.webm" type="video\/webm; codecs=&quot;vp9, opus&quot;" data-title="VP9 (360P)" data-shorttitle="VP9 360P" data-transcodekey="360p.vp9.webm" data-width="360" data-height="360" data-bandwidth="221152" data-framerate="20"\/><source src="\/\/upload.wikimedia.org\/wikipedia\/commons\/transcoded\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/Real-time_MRI_-_Thorax.ogv.360p.webm" type="video\/webm; codecs=&quot;vp8, vorbis&quot;" data-title="WebM (360P)" data-shorttitle="WebM 360P" data-transcodekey="360p.webm" data-width="360" data-height="360" data-bandwidth="503040" data-framerate="20"\/><\/video><\/div>\"><img alt=\"File:Real-time MRI - Thorax.ogv\" style=\"width:220px;height:220px\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/dd\/Real-time_MRI_-_Thorax.ogv\/220px--Real-time_MRI_-_Thorax.ogv.jpg\" \/><a href=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/d\/dd\/Real-time_MRI_-_Thorax.ogv\" title=\"Play media\" target=\"_blank\" rel=\"external_link\"><span class=\"play-btn-large\"><span class=\"mw-tmh-playtext\">Play media<\/span><\/span><\/a><\/div> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Real-time_MRI_-_Thorax.ogv\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Real-time MRI of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_heart\" class=\"mw-redirect\" title=\"Human heart\" rel=\"external_link\" target=\"_blank\">human heart<\/a> at a resolution of 50 ms<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Real-time_MRI\" title=\"Real-time MRI\" rel=\"external_link\" target=\"_blank\">Real-time MRI<\/a><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Real-time_MRI\" title=\"Real-time MRI\" rel=\"external_link\" target=\"_blank\">Real-time MRI<\/a> refers to the continuous imaging of moving objects (such as the heart) in real time. One of the many different strategies developed since the early 2000s is based on radial <a href=\"https:\/\/en.wikipedia.org\/wiki\/FLASH_MRI\" class=\"mw-redirect\" title=\"FLASH MRI\" rel=\"external_link\" target=\"_blank\">FLASH MRI<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iterative_reconstruction\" title=\"Iterative reconstruction\" rel=\"external_link\" target=\"_blank\">iterative reconstruction<\/a>. This gives a temporal resolution of 20\u201330 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Millisecond\" title=\"Millisecond\" rel=\"external_link\" target=\"_blank\">ms<\/a> for images with an in-plane resolution of 1.5\u20132.0 mm.<sup id=\"rdp-ebb-cite_ref-Uecker_71-0\" class=\"reference\"><a href=\"#cite_note-Uecker-71\" rel=\"external_link\">[71]<\/a><\/sup> Balanced has a better image contrast between the blood pool and myocardium than the <a href=\"https:\/\/en.wikipedia.org\/wiki\/FLASH_MRI\" class=\"mw-redirect\" title=\"FLASH MRI\" rel=\"external_link\" target=\"_blank\">FLASH MRI<\/a>, yet it will produce severe banding artifact when the B0 inhomogeneity is strong. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Real-time_MRI\" title=\"Real-time MRI\" rel=\"external_link\" target=\"_blank\">Real-time MRI<\/a> is likely to add important information on diseases of the heart and the joints, and in many cases may make MRI examinations easier and more comfortable for patients, especially for the patients who cannot hold their breathings or who have arrhythmia.<sup id=\"rdp-ebb-cite_ref-UyanikLindner2013_72-0\" class=\"reference\"><a href=\"#cite_note-UyanikLindner2013-72\" rel=\"external_link\">[72]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Interventional_MRI\">Interventional MRI<\/span><\/h4>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_magnetic_resonance_imaging\" title=\"Interventional magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">Interventional magnetic resonance imaging<\/a><\/div>\n<p>The lack of harmful effects on the patient and the operator make MRI well-suited for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_radiology\" title=\"Interventional radiology\" rel=\"external_link\" target=\"_blank\">interventional radiology<\/a>, where the images produced by an MRI scanner guide minimally invasive procedures. Such procedures use no <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferromagnetic\" class=\"mw-redirect\" title=\"Ferromagnetic\" rel=\"external_link\" target=\"_blank\">ferromagnetic<\/a> instruments.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>A specialized growing subset of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_magnetic_resonance_imaging\" title=\"Interventional magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">interventional MRI<\/a> is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intraoperative_MRI\" title=\"Intraoperative MRI\" rel=\"external_link\" target=\"_blank\">intraoperative MRI<\/a>, in which an MRI is used in surgery. Some specialized MRI systems allow imaging concurrent with the surgical procedure. More typically, the surgical procedure is temporarily interrupted so that MRI can assess the success of the procedure or guide subsequent surgical work.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (July 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Magnetic_resonance_guided_focused_ultrasound\">Magnetic resonance guided focused ultrasound<\/span><\/h4>\n<p>In guided therapy, <a href=\"https:\/\/en.wikipedia.org\/wiki\/High-intensity_focused_ultrasound\" title=\"High-intensity focused ultrasound\" rel=\"external_link\" target=\"_blank\">high-intensity focused ultrasound<\/a> (HIFU) beams are focused on a tissue, that are controlled using MR thermal imaging. Due to the high energy at the focus, the temperature rises to above 65 <a href=\"https:\/\/en.wikipedia.org\/wiki\/%C2%B0C\" class=\"mw-redirect\" title=\"\u00b0C\" rel=\"external_link\" target=\"_blank\">\u00b0C<\/a> (150 \u00b0F) which completely destroys the tissue. This technology can achieve precise <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ablation\" title=\"Ablation\" rel=\"external_link\" target=\"_blank\">ablation<\/a> of diseased tissue. MR imaging provides a three-dimensional view of the target tissue, allowing for the precise focusing of ultrasound energy. The MR imaging provides quantitative, real-time, thermal images of the treated area. This allows the physician to ensure that the temperature generated during each cycle of ultrasound energy is sufficient to cause thermal ablation within the desired tissue and if not, to adapt the parameters to ensure effective treatment.<sup id=\"rdp-ebb-cite_ref-73\" class=\"reference\"><a href=\"#cite_note-73\" rel=\"external_link\">[73]<\/a><\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Multinuclear_imaging\">Multinuclear imaging<\/span><\/h4>\n<p>Hydrogen has the most frequently imaged <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atomic_nucleus\" title=\"Atomic nucleus\" rel=\"external_link\" target=\"_blank\">nucleus<\/a> in MRI because it is present in biological tissues in great abundance, and because its high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gyromagnetic_ratio\" title=\"Gyromagnetic ratio\" rel=\"external_link\" target=\"_blank\">gyromagnetic ratio<\/a> gives a strong signal. However, any nucleus with a net <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spin_(physics)\" title=\"Spin (physics)\" rel=\"external_link\" target=\"_blank\">nuclear spin<\/a> could potentially be imaged with MRI. Such nuclei include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Helium\" title=\"Helium\" rel=\"external_link\" target=\"_blank\">helium<\/a>-3, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithium\" title=\"Lithium\" rel=\"external_link\" target=\"_blank\">lithium<\/a>-7, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon\" title=\"Carbon\" rel=\"external_link\" target=\"_blank\">carbon<\/a>-13, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorine\" title=\"Fluorine\" rel=\"external_link\" target=\"_blank\">fluorine<\/a>-19, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen-17\" title=\"Oxygen-17\" rel=\"external_link\" target=\"_blank\">oxygen-17<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium\" title=\"Sodium\" rel=\"external_link\" target=\"_blank\">sodium<\/a>-23, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphorus\" title=\"Phosphorus\" rel=\"external_link\" target=\"_blank\">phosphorus<\/a>-31 and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Xenon#Isotopes\" title=\"Xenon\" rel=\"external_link\" target=\"_blank\">xenon-129<\/a>. <sup>23<\/sup>Na and <sup>31<\/sup>P are naturally abundant in the body, so can be imaged directly. Gaseous isotopes such as <sup>3<\/sup>He or <sup>129<\/sup>Xe must be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperpolarization_(physics)\" title=\"Hyperpolarization (physics)\" rel=\"external_link\" target=\"_blank\">hyperpolarized<\/a> and then inhaled as their nuclear density is too low to yield a useful signal under normal conditions. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen-17\" title=\"Oxygen-17\" rel=\"external_link\" target=\"_blank\"><sup>17<\/sup>O<\/a> and <sup>19<\/sup>F can be administered in sufficient quantities in liquid form (e.g. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oxygen-17\" title=\"Oxygen-17\" rel=\"external_link\" target=\"_blank\"><sup>17<\/sup>O<\/a>-water) that hyperpolarization is not a necessity.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2010)\">citation needed<\/span><\/a><\/i>]<\/sup> Using helium or xenon has the advantage of reduced background noise, and therefore increased contrast for the image itself, because these elements are not normally present in biological tissues.<sup id=\"rdp-ebb-cite_ref-74\" class=\"reference\"><a href=\"#cite_note-74\" rel=\"external_link\">[74]<\/a><\/sup>\n<\/p><p>Moreover, the nucleus of any atom that has a net nuclear spin and that is bonded to a hydrogen atom could potentially be imaged via heteronuclear magnetization transfer MRI that would image the high-gyromagnetic-ratio hydrogen nucleus instead of the low-gyromagnetic-ratio nucleus that is bonded to the hydrogen atom.<sup id=\"rdp-ebb-cite_ref-75\" class=\"reference\"><a href=\"#cite_note-75\" rel=\"external_link\">[75]<\/a><\/sup> In principle, hetereonuclear magnetization transfer MRI could be used to detect the presence or absence of specific chemical bonds.<sup id=\"rdp-ebb-cite_ref-76\" class=\"reference\"><a href=\"#cite_note-76\" rel=\"external_link\">[76]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-77\" class=\"reference\"><a href=\"#cite_note-77\" rel=\"external_link\">[77]<\/a><\/sup>\n<\/p><p>Multinuclear imaging is primarily a research technique at present. However, potential applications include functional imaging and imaging of organs poorly seen on <sup>1<\/sup>H MRI (e.g., lungs and bones) or as alternative contrast agents. Inhaled hyperpolarized <sup>3<\/sup>He can be used to image the distribution of air spaces within the lungs. Injectable solutions containing <sup>13<\/sup>C or stabilized bubbles of hyperpolarized <sup>129<\/sup>Xe have been studied as contrast agents for angiography and perfusion imaging. <sup>31<\/sup>P can potentially provide information on bone density and structure, as well as functional imaging of the brain. Multinuclear imaging holds the potential to chart the distribution of lithium in the human brain, this element finding use as an important drug for those with conditions such as bipolar disorder.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2010)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Molecular_imaging_by_MRI\">Molecular imaging by MRI<\/span><\/h4>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_imaging\" title=\"Molecular imaging\" rel=\"external_link\" target=\"_blank\">Molecular imaging<\/a><\/div>\n<p>MRI has the advantages of having very high spatial resolution and is very adept at morphological imaging and functional imaging. MRI does have several disadvantages though. First, MRI has a sensitivity of around 10<sup>\u22123<\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Concentration#Molarity\" title=\"Concentration\" rel=\"external_link\" target=\"_blank\">mol\/L<\/a> to 10<sup>\u22125<\/sup> mol\/L, which, compared to other types of imaging, can be very limiting. This problem stems from the fact that the population difference between the nuclear spin states is very small at room temperature. For example, at 1.5 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tesla_(unit)\" title=\"Tesla (unit)\" rel=\"external_link\" target=\"_blank\">teslas<\/a>, a typical field strength for clinical MRI, the difference between high and low energy states is approximately 9 molecules per 2 million. Improvements to increase MR sensitivity include increasing magnetic field strength, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperpolarization_(physics)\" title=\"Hyperpolarization (physics)\" rel=\"external_link\" target=\"_blank\">hyperpolarization<\/a> via optical pumping or dynamic nuclear polarization. There are also a variety of signal amplification schemes based on chemical exchange that increase sensitivity.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (July 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>To achieve molecular imaging of disease biomarkers using MRI, targeted MRI contrast agents with high specificity and high relaxivity (sensitivity) are required. To date, many studies have been devoted to developing targeted-MRI contrast agents to achieve molecular imaging by MRI. Commonly, peptides, antibodies, or small ligands, and small protein domains, such as HER-2 affibodies, have been applied to achieve targeting. To enhance the sensitivity of the contrast agents, these targeting moieties are usually linked to high payload MRI contrast agents or MRI contrast agents with high relaxivities.<sup id=\"rdp-ebb-cite_ref-78\" class=\"reference\"><a href=\"#cite_note-78\" rel=\"external_link\">[78]<\/a><\/sup> A new class of gene targeting MR contrast agents (CA) has been introduced to show gene action of unique mRNA and gene transcription factor proteins.<sup id=\"rdp-ebb-cite_ref-pmid17234603_79-0\" class=\"reference\"><a href=\"#cite_note-pmid17234603-79\" rel=\"external_link\">[79]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid24115049_80-0\" class=\"reference\"><a href=\"#cite_note-pmid24115049-80\" rel=\"external_link\">[80]<\/a><\/sup> This new CA can trace cells with unique mRNA, microRNA and virus; tissue response to inflammation in living brains.<sup id=\"rdp-ebb-cite_ref-pmid19295156_81-0\" class=\"reference\"><a href=\"#cite_note-pmid19295156-81\" rel=\"external_link\">[81]<\/a><\/sup> The MR reports change in gene expression with positive correlation to TaqMan analysis, optical and electron microscopy.<sup id=\"rdp-ebb-cite_ref-pmid23150521_82-0\" class=\"reference\"><a href=\"#cite_note-pmid23150521-82\" rel=\"external_link\">[82]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Economics\">Economics<\/span><\/h2>\n<p>In the UK, the price of a clinical 1.5-tesla MRI scanner is around \u00a3920,000\/<span style=\"white-space: nowrap\">US$1.4 million<\/span>, with the lifetime maintenance cost broadly similar to the purchase cost.<sup id=\"rdp-ebb-cite_ref-83\" class=\"reference\"><a href=\"#cite_note-83\" rel=\"external_link\">[83]<\/a><\/sup> In the Netherlands, the average MRI scanner costs around \u20ac1 million,<sup id=\"rdp-ebb-cite_ref-84\" class=\"reference\"><a href=\"#cite_note-84\" rel=\"external_link\">[84]<\/a><\/sup> with a 7-T MRI having been taken in use by the UMC Utrecht in December 2007, costing \u20ac7 million.<sup id=\"rdp-ebb-cite_ref-85\" class=\"reference\"><a href=\"#cite_note-85\" rel=\"external_link\">[85]<\/a><\/sup> Construction of MRI suites could cost up to <span style=\"white-space: nowrap\">US$500,000<\/span>\/\u20ac370.000 or more, depending on project scope. Pre-polarizing MRI (PMRI) systems using resistive electromagnets have shown promise as a low-cost alternative and have specific advantages for joint imaging near metal implants, however they are likely unsuitable for routine whole-body or neuroimaging applications.<sup id=\"rdp-ebb-cite_ref-MorganConolly1996_86-0\" class=\"reference\"><a href=\"#cite_note-MorganConolly1996-86\" rel=\"external_link\">[86]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Blamire2008_87-0\" class=\"reference\"><a href=\"#cite_note-Blamire2008-87\" rel=\"external_link\">[87]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Modern_3T_MRI.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/Modern_3T_MRI.JPG\/220px-Modern_3T_MRI.JPG\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Modern_3T_MRI.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A 3 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tesla_(unit)\" title=\"Tesla (unit)\" rel=\"external_link\" target=\"_blank\">tesla<\/a> clinical MRI scanner.<\/div><\/div><\/div>\n<p>MRI scanners have become significant sources of revenue for healthcare providers in the US. This is because of favorable reimbursement rates from insurers and federal government programs. Insurance reimbursement is provided in two components, an equipment charge for the actual performance and operation of the MRI scan and a professional charge for the radiologist's review of the images and\/or data. In the US Northeast, an equipment charge might be $3,500\/\u20ac2,600 and a professional charge might be $350\/\u20ac260,<sup id=\"rdp-ebb-cite_ref-88\" class=\"reference\"><a href=\"#cite_note-88\" rel=\"external_link\">[88]<\/a><\/sup> although the actual fees received by the equipment owner and interpreting physician are often significantly less and depend on the rates negotiated with insurance companies or determined by the Medicare fee schedule. For example, an orthopedic surgery group in Illinois billed a charge of $1,116\/\u20ac825 for a knee MRI in 2007, but the Medicare reimbursement in 2007 was only $470.91\/\u20ac350.<sup id=\"rdp-ebb-cite_ref-89\" class=\"reference\"><a href=\"#cite_note-89\" rel=\"external_link\">[89]<\/a><\/sup> Many insurance companies require advance approval of an MRI procedure as a condition for coverage.\n<\/p><p>In the US, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deficit_Reduction_Act_of_2005\" title=\"Deficit Reduction Act of 2005\" rel=\"external_link\" target=\"_blank\">Deficit Reduction Act of 2005<\/a> significantly reduced reimbursement rates paid by federal insurance programs for the equipment component of many scans, shifting the economic landscape. Many private insurers have followed suit.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2008)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>In the United States, an MRI of the brain with and without contrast billed to Medicare Part B entails, on average, a technical payment of <span style=\"white-space: nowrap\">US$403<\/span>\/\u20ac300 and a separate payment to the radiologist of <span style=\"white-space: nowrap\">US$93<\/span>\/\u20ac70.<sup id=\"rdp-ebb-cite_ref-90\" class=\"reference\"><a href=\"#cite_note-90\" rel=\"external_link\">[90]<\/a><\/sup> In France, the cost of an MRI exam is approximately \u20ac150\/<span style=\"white-space: nowrap\">US$205<\/span>. This covers three basic scans including one with an intravenous contrast agent as well as a consultation with the technician and a written report to the patient's physician.<sup id=\"rdp-ebb-cite_ref-91\" class=\"reference\"><a href=\"#cite_note-91\" rel=\"external_link\">[91]<\/a><\/sup> In Japan, the cost of an MRI examination (excluding the cost of contrast material and films) ranges from <span style=\"white-space: nowrap\">US$155<\/span>\/\u20ac115 to <span style=\"white-space: nowrap\">US$180<\/span>\/\u20ac133, with an additional radiologist professional fee of <span style=\"white-space: nowrap\">US$17<\/span>\/\u20ac12.50.<sup id=\"rdp-ebb-cite_ref-92\" class=\"reference\"><a href=\"#cite_note-92\" rel=\"external_link\">[92]<\/a><\/sup> In India, the cost of an MRI examination including the fee for the radiologist's opinion comes to around Rs 3000\u20134000 (\u20ac37\u201349\/<span style=\"white-space: nowrap\">US$50\u201360<\/span>), excluding the cost of contrast material. In the UK the retail price for an MRI scan privately ranges between \u00a3350 and \u00a3700 (\u20ac405\u2013810).<sup id=\"rdp-ebb-cite_ref-93\" class=\"reference\"><a href=\"#cite_note-93\" rel=\"external_link\">[93]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Clinical_MRI_installation_in_a_general_hospital\">Clinical MRI installation in a general hospital<\/span><\/h3>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:41px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Wx_camera_1507509040946.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0b\/Wx_camera_1507509040946.jpg\/120px-Wx_camera_1507509040946.jpg\" width=\"120\" height=\"68\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Control console\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Wx_camera_1507509050808.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Wx_camera_1507509050808.jpg\/67px-Wx_camera_1507509050808.jpg\" width=\"67\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Bore camera\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:41px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Wx_camera_1507512102648.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/91\/Wx_camera_1507512102648.jpg\/120px-Wx_camera_1507512102648.jpg\" width=\"120\" height=\"68\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Operator performing a scan\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Wx_camera_1507514479961.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1a\/Wx_camera_1507514479961.jpg\/67px-Wx_camera_1507514479961.jpg\" width=\"67\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Technical area\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h2><span class=\"mw-headline\" id=\"Safety\">Safety<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Safety_of_magnetic_resonance_imaging\" title=\"Safety of magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">Safety of magnetic resonance imaging<\/a><\/div>\n<p>MRI is in general a safe technique, although injuries may occur as a result of failed safety procedures or human error.<sup id=\"rdp-ebb-cite_ref-94\" class=\"reference\"><a href=\"#cite_note-94\" rel=\"external_link\">[94]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Contraindications\" class=\"mw-redirect\" title=\"Contraindications\" rel=\"external_link\" target=\"_blank\">Contraindications<\/a> to MRI include most <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cochlear_implant\" title=\"Cochlear implant\" rel=\"external_link\" target=\"_blank\">cochlear implants<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artificial_cardiac_pacemaker\" title=\"Artificial cardiac pacemaker\" rel=\"external_link\" target=\"_blank\">cardiac pacemakers<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fragmentation_(weaponry)\" title=\"Fragmentation (weaponry)\" rel=\"external_link\" target=\"_blank\">shrapnel<\/a>, and metallic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign_body\" title=\"Foreign body\" rel=\"external_link\" target=\"_blank\">foreign bodies<\/a> in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orbit_(anatomy)\" title=\"Orbit (anatomy)\" rel=\"external_link\" target=\"_blank\">eyes<\/a>. The safety of MRI during the first trimester of pregnancy is uncertain, but it may be preferable to other options.<sup id=\"rdp-ebb-cite_ref-WangChong2012_95-0\" class=\"reference\"><a href=\"#cite_note-WangChong2012-95\" rel=\"external_link\">[95]<\/a><\/sup> Since MRI does not use any ionizing radiation, its use is generally favored in preference to <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray_computed_tomography\" class=\"mw-redirect\" title=\"X-ray computed tomography\" rel=\"external_link\" target=\"_blank\">CT<\/a> when either modality could yield the same information.<sup id=\"rdp-ebb-cite_ref-iRefer_96-0\" class=\"reference\"><a href=\"#cite_note-iRefer-96\" rel=\"external_link\">[96]<\/a><\/sup> In certain cases, MRI is not preferred as it may be more expensive, time-consuming, and claustrophobia-exacerbating.\n<\/p><p>MRI uses powerful magnets and can therefore cause <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ferromagnetism\" title=\"Ferromagnetism\" rel=\"external_link\" target=\"_blank\">magnetic materials<\/a> to move at great speeds posing risk. Deaths have occurred.<sup id=\"rdp-ebb-cite_ref-97\" class=\"reference\"><a href=\"#cite_note-97\" rel=\"external_link\">[97]<\/a><\/sup> However, as millions of MRIs are performed globally each year.,<sup id=\"rdp-ebb-cite_ref-98\" class=\"reference\"><a href=\"#cite_note-98\" rel=\"external_link\">[98]<\/a><\/sup> fatalities are extremely rare.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Overuse\">Overuse<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Overdiagnosis\" title=\"Overdiagnosis\" rel=\"external_link\" target=\"_blank\">Overdiagnosis<\/a><\/div>\n<p>Medical societies issue guidelines for when physicians should use MRI on patients and recommend against overuse. MRI can detect health problems or confirm a diagnosis, but medical societies often recommend that MRI not be the first procedure for creating a plan to diagnose or manage a patient's complaint. A common case is to use MRI to seek a cause of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Low_back_pain\" title=\"Low back pain\" rel=\"external_link\" target=\"_blank\">low back pain<\/a>; the <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_College_of_Physicians\" title=\"American College of Physicians\" rel=\"external_link\" target=\"_blank\">American College of Physicians<\/a>, for example, recommends against this procedure as unlikely to result in a positive outcome for the patient.<sup id=\"rdp-ebb-cite_ref-ACPfive_99-0\" class=\"reference\"><a href=\"#cite_note-ACPfive-99\" rel=\"external_link\">[99]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-backimage_100-0\" class=\"reference\"><a href=\"#cite_note-backimage-100\" rel=\"external_link\">[100]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Artifacts\">Artifacts<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MRI_with_motion_artifacts.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/aa\/MRI_with_motion_artifacts.jpg\/220px-MRI_with_motion_artifacts.jpg\" width=\"220\" height=\"194\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MRI_with_motion_artifacts.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Motion artifact (T1 coronal study of cervical vertebrae).<sup id=\"rdp-ebb-cite_ref-ErasmusHurter2004_101-0\" class=\"reference\"><a href=\"#cite_note-ErasmusHurter2004-101\" rel=\"external_link\">[101]<\/a><\/sup><\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_artifact\" title=\"MRI artifact\" rel=\"external_link\" target=\"_blank\">MRI artifact<\/a><\/div>\n<p>An <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI_artifact\" title=\"MRI artifact\" rel=\"external_link\" target=\"_blank\">MRI artifact<\/a> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Visual_artifact\" title=\"Visual artifact\" rel=\"external_link\" target=\"_blank\">visual artifact<\/a>, that is, an anomaly during visual representation. Many different artifacts can occur\nduring magnetic resonance imaging (MRI), some affecting the diagnostic quality, while others may be confused with pathology. Artifacts can be classified as patient-related, signal processing-dependent and hardware (machine)-related.<sup id=\"rdp-ebb-cite_ref-ErasmusHurter2004_101-1\" class=\"reference\"><a href=\"#cite_note-ErasmusHurter2004-101\" rel=\"external_link\">[101]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Non-medical_use\">Non-medical use<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance#Applications\" title=\"Nuclear magnetic resonance\" rel=\"external_link\" target=\"_blank\">Nuclear magnetic resonance \u00a7 Applications<\/a><\/div>\n<p>MRI is used industrially mainly for routine analysis of chemicals. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuclear_magnetic_resonance\" title=\"Nuclear magnetic resonance\" rel=\"external_link\" target=\"_blank\">nuclear magnetic resonance<\/a> technique is also used, for example, to measure the ratio between water and fat in foods, monitoring of flow of corrosive fluids in pipes, or to study molecular structures such as catalysts.<sup id=\"rdp-ebb-cite_ref-non-medical_102-0\" class=\"reference\"><a href=\"#cite_note-non-medical-102\" rel=\"external_link\">[102]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/History_of_magnetic_resonance_imaging\" title=\"History of magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">History of magnetic resonance imaging<\/a><\/div>\n<p>In 1971, Paul Lauterbur applied magnetic field gradients in all three dimensions and a back-projection technique to create NMR images. He published the first images of two tubes of water in 1973 in the journal <i>Nature<\/i>, followed by the picture of a living animal, a clam, and in 1974 by the image of the thoracic cavity of a mouse. Lauterbur called his imaging method zeugmatography, a term which was later replaced by (N)MR imaging.<sup id=\"rdp-ebb-cite_ref-103\" class=\"reference\"><a href=\"#cite_note-103\" rel=\"external_link\">[103]<\/a><\/sup> In the late 1970s, physicists <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peter_Mansfield\" title=\"Peter Mansfield\" rel=\"external_link\" target=\"_blank\">Peter Mansfield<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paul_Lauterbur\" title=\"Paul Lauterbur\" rel=\"external_link\" target=\"_blank\">Paul Lauterbur<\/a>, developed MRI-related techniques, like the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Echo-planar_imaging\" class=\"mw-redirect\" title=\"Echo-planar imaging\" rel=\"external_link\" target=\"_blank\">echo-planar imaging<\/a> (EPI) technique.<sup id=\"rdp-ebb-cite_ref-Mansfield-EPI_104-0\" class=\"reference\"><a href=\"#cite_note-Mansfield-EPI-104\" rel=\"external_link\">[104]<\/a><\/sup> Mansfield and Lauterbur were awarded the 2003 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nobel_Prize_in_Physiology_or_Medicine\" title=\"Nobel Prize in Physiology or Medicine\" rel=\"external_link\" target=\"_blank\">Nobel Prize in Physiology or Medicine<\/a> for their \"discoveries concerning magnetic resonance imaging\".\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div role=\"navigation\" aria-label=\"Portals\" class=\"noprint portal plainlist tright\" style=\"margin:0.5em 0 0.5em 1em;border:solid #aaa 1px\">\n<ul style=\"display:table;box-sizing:border-box;padding:0.1em;max-width:175px;background:#f9f9f9;font-size:85%;line-height:110%;font-style:italic;font-weight:bold\">\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><img alt=\"icon\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/WHO_Rod.svg\/12px-WHO_Rod.svg.png\" width=\"12\" height=\"28\" class=\"noviewer\" \/><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Medicine\" title=\"Portal:Medicine\" rel=\"external_link\" target=\"_blank\">Medicine portal<\/a><\/span><\/li><\/ul><\/div>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 22em; -webkit-column-width: 22em; column-width: 22em;\">\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Earth%27s_field_NMR\" title=\"Earth's field NMR\" rel=\"external_link\" target=\"_blank\">Earth's field NMR<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electron_paramagnetic_resonance\" title=\"Electron paramagnetic resonance\" rel=\"external_link\" target=\"_blank\">Electron paramagnetic resonance<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/High-definition_fiber_tracking\" title=\"High-definition fiber tracking\" rel=\"external_link\" target=\"_blank\">High-definition fiber tracking<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/History_of_neuroimaging\" title=\"History of neuroimaging\" rel=\"external_link\" target=\"_blank\">History of neuroimaging<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Society_of_Magnetic_Resonance_in_Medicine\" title=\"International Society of Magnetic Resonance in Medicine\" rel=\"external_link\" target=\"_blank\">International Society of Magnetic Resonance in Medicine<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Jemris\" title=\"Jemris\" rel=\"external_link\" target=\"_blank\">Jemris<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_neuroimaging_software\" title=\"List of neuroimaging software\" rel=\"external_link\" target=\"_blank\">List of neuroimaging software<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_immunoassay\" title=\"Magnetic immunoassay\" rel=\"external_link\" target=\"_blank\">Magnetic immunoassay<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_particle_imaging\" title=\"Magnetic particle imaging\" rel=\"external_link\" target=\"_blank\">Magnetic particle imaging<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_elastography\" title=\"Magnetic resonance elastography\" rel=\"external_link\" target=\"_blank\">Magnetic resonance elastography<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_Resonance_Imaging_(journal)\" title=\"Magnetic Resonance Imaging (journal)\" rel=\"external_link\" target=\"_blank\"><i>Magnetic Resonance Imaging<\/i> (journal)<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_microscopy\" title=\"Magnetic resonance microscopy\" rel=\"external_link\" target=\"_blank\">Magnetic resonance microscopy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nobel_Prize_controversies\" title=\"Nobel Prize controversies\" rel=\"external_link\" target=\"_blank\">Nobel Prize controversies<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Rabi_cycle\" title=\"Rabi cycle\" rel=\"external_link\" target=\"_blank\">Rabi cycle<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Robinson_oscillator\" title=\"Robinson oscillator\" rel=\"external_link\" target=\"_blank\">Robinson oscillator<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sodium_MRI\" title=\"Sodium MRI\" rel=\"external_link\" target=\"_blank\">Sodium MRI<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Virtopsy\" title=\"Virtopsy\" rel=\"external_link\" target=\"_blank\">Virtopsy<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/High-resolution_computed_tomography\" title=\"High-resolution computed tomography\" rel=\"external_link\" target=\"_blank\">High-resolution computed tomography<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Super-resolution_imaging\" title=\"Super-resolution imaging\" rel=\"external_link\" target=\"_blank\">Super-resolution imaging<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Compressed_sensing\" title=\"Compressed sensing\" rel=\"external_link\" target=\"_blank\">Compressed sensing<\/a><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 32em; -webkit-column-width: 32em; column-width: 32em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">McRobbie DW, Moore EA, Graves MJ, Prince MR (2007). <i>MRI from Picture to Proton<\/i>. Cambridge University Press. p. 1. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-139-45719-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=MRI+from+Picture+to+Proton&rft.pages=1&rft.pub=Cambridge+University+Press&rft.date=2007&rft.isbn=978-1-139-45719-4&rft.aulast=McRobbie&rft.aufirst=Donald+W.&rft.au=Moore%2C+Elizabeth+A.&rft.au=Graves%2C+Martin+J.&rft.au=Prince%2C+Martin+R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Smith-Bindman2012-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Smith-Bindman2012_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Smith-Bindman R, Miglioretti DL, Johnson E, Lee C, Feigelson HS, Flynn M, et al. (June 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3859870\" target=\"_blank\">\"Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010\"<\/a>. <i>Jama<\/i>. <b>307<\/b> (22): 2400\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1001%2Fjama.2012.5960\" target=\"_blank\">10.1001\/jama.2012.5960<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3859870\" target=\"_blank\">3859870<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22692172\" target=\"_blank\">22692172<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Jama&rft.atitle=Use+of+diagnostic+imaging+studies+and+associated+radiation+exposure+for+patients+enrolled+in+large+integrated+health+care+systems%2C+1996-2010&rft.volume=307&rft.issue=22&rft.pages=2400-9&rft.date=2012-06&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3859870&rft_id=info%3Apmid%2F22692172&rft_id=info%3Adoi%2F10.1001%2Fjama.2012.5960&rft.aulast=Smith-Bindman&rft.aufirst=R&rft.au=Miglioretti%2C+DL&rft.au=Johnson%2C+E&rft.au=Lee%2C+C&rft.au=Feigelson%2C+HS&rft.au=Flynn%2C+M&rft.au=Greenlee%2C+RT&rft.au=Kruger%2C+RL&rft.au=Hornbrook%2C+MC&rft.au=Roblin%2C+D&rft.au=Solberg%2C+LI&rft.au=Vanneman%2C+N&rft.au=Weinmann%2C+S&rft.au=Williams%2C+AE&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3859870&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><i>Health at a glance 2009 OECD indicators<\/i>. Health at a Glance. 2009. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1787%2Fhealth_glance-2009-en\" target=\"_blank\">10.1787\/health_glance-2009-en<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-92-64-07555-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Health+at+a+glance+2009+OECD+indicators&rft.series=Health+at+a+Glance&rft.date=2009&rft_id=info%3Adoi%2F10.1787%2Fhealth_glance-2009-en&rft.isbn=978-92-64-07555-9&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-McRobbie-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-McRobbie_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-McRobbie_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">McRobbie DW (2007). <i>MRI from picture to proton<\/i>. Cambridge, UK; New York: Cambridge University Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-521-68384-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=MRI+from+picture+to+proton&rft.place=Cambridge%2C+UK%3B+New+York&rft.pub=Cambridge+University+Press&rft.date=2007&rft.isbn=978-0-521-68384-5&rft.aulast=McRobbie&rft.aufirst=Donald+W.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sasaki M, Ehara S, Nakasato T, Tamakawa Y, Kuboya Y, Sugisawa M, Sato T (April 1990). \"MR of the shoulder with a 0.2-T permanent-magnet unit\". <i>AJR. American Journal of Roentgenology<\/i>. <b>154<\/b> (4): 777\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2214%2Fajr.154.4.2107675\" target=\"_blank\">10.2214\/ajr.154.4.2107675<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2107675\" target=\"_blank\">2107675<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AJR.+American+Journal+of+Roentgenology&rft.atitle=MR+of+the+shoulder+with+a+0.2-T+permanent-magnet+unit&rft.volume=154&rft.issue=4&rft.pages=777-8&rft.date=1990-04&rft_id=info%3Adoi%2F10.2214%2Fajr.154.4.2107675&rft_id=info%3Apmid%2F2107675&rft.aulast=Sasaki&rft.aufirst=M&rft.au=Ehara%2C+S&rft.au=Nakasato%2C+T&rft.au=Tamakawa%2C+Y&rft.au=Kuboya%2C+Y&rft.au=Sugisawa%2C+M&rft.au=Sato%2C+T&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">McDermott R, Lee S, ten Haken B, Trabesinger AH, Pines A, Clarke J (May 2004). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC419521\" target=\"_blank\">\"Microtesla MRI with a superconducting quantum interference device\"<\/a>. <i>Proceedings of the National Academy of Sciences of the United States of America<\/i>. <b>101<\/b> (21): 7857\u201361. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1073%2Fpnas.0402382101\" target=\"_blank\">10.1073\/pnas.0402382101<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC419521\" target=\"_blank\">419521<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15141077\" target=\"_blank\">15141077<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+National+Academy+of+Sciences+of+the+United+States+of+America&rft.atitle=Microtesla+MRI+with+a+superconducting+quantum+interference+device&rft.volume=101&rft.issue=21&rft.pages=7857-61&rft.date=2004-05&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC419521&rft_id=info%3Apmid%2F15141077&rft_id=info%3Adoi%2F10.1073%2Fpnas.0402382101&rft.aulast=McDermott&rft.aufirst=R&rft.au=Lee%2C+S&rft.au=ten+Haken%2C+B&rft.au=Trabesinger%2C+AH&rft.au=Pines%2C+A&rft.au=Clarke%2C+J&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC419521&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zotev VS, Matlashov AN, Volegov PL, Urbaitis AV, Espy MA, Kraus Jr RH (2007). \"SQUID-based instrumentation for ultralow-field MRI\". <i>Superconductor Science and Technology<\/i>. <b>20<\/b> (11): S367\u2013S373. <a href=\"https:\/\/en.wikipedia.org\/wiki\/ArXiv\" title=\"ArXiv\" rel=\"external_link\" target=\"_blank\">arXiv<\/a>:<span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/arxiv.org\/abs\/0705.0661\" target=\"_blank\">0705.0661<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1088%2F0953-2048%2F20%2F11%2FS13\" target=\"_blank\">10.1088\/0953-2048\/20\/11\/S13<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Superconductor+Science+and+Technology&rft.atitle=SQUID-based+instrumentation+for+ultralow-field+MRI&rft.volume=20&rft.issue=11&rft.pages=S367-S373&rft.date=2007&rft_id=info%3Aarxiv%2F0705.0661&rft_id=info%3Adoi%2F10.1088%2F0953-2048%2F20%2F11%2FS13&rft.aulast=Zotev&rft.aufirst=Vadim+S&rft.au=Matlashov%2C+Andrei+N&rft.au=Volegov%2C+Petr+L&rft.au=Urbaitis%2C+Algis+V&rft.au=Espy%2C+Michelle+A&rft.au=Kraus+Jr%2C+Robert+H&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vesanen PT, Nieminen JO, Zevenhoven KC, Dabek J, Parkkonen LT, Zhdanov AV, Luomahaara J, Hassel J, Penttil\u00e4 J, Simola J, Ahonen AI, M\u00e4kel\u00e4 JP, Ilmoniemi RJ (June 2013). \"Hybrid ultra-low-field MRI and magnetoencephalography system based on a commercial whole-head neuromagnetometer\". <i>Magnetic Resonance in Medicine<\/i>. <b>69<\/b> (6): 1795\u2013804. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fmrm.24413\" target=\"_blank\">10.1002\/mrm.24413<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22807201\" target=\"_blank\">22807201<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Magnetic+Resonance+in+Medicine&rft.atitle=Hybrid+ultra-low-field+MRI+and+magnetoencephalography+system+based+on+a+commercial+whole-head+neuromagnetometer&rft.volume=69&rft.issue=6&rft.pages=1795-804&rft.date=2013-06&rft_id=info%3Adoi%2F10.1002%2Fmrm.24413&rft_id=info%3Apmid%2F22807201&rft.aulast=Vesanen&rft.aufirst=PT&rft.au=Nieminen%2C+JO&rft.au=Zevenhoven%2C+KC&rft.au=Dabek%2C+J&rft.au=Parkkonen%2C+LT&rft.au=Zhdanov%2C+AV&rft.au=Luomahaara%2C+J&rft.au=Hassel%2C+J&rft.au=Penttil%C3%A4%2C+J&rft.au=Simola%2C+J&rft.au=Ahonen%2C+AI&rft.au=M%C3%A4kel%C3%A4%2C+JP&rft.au=Ilmoniemi%2C+RJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-wisconsin-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-wisconsin_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wisconsin_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wisconsin_9-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wisconsin_9-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wisconsin_9-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wisconsin_9-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wisconsin_9-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-wisconsin_9-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170510065614\/https:\/\/www.radiology.wisc.edu\/education\/med_students\/neuroradiology\/NeuroRad\/Intro\/MRIintro.htm\" target=\"_blank\">\"Magnetic Resonance Imaging\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Wisconsin\" class=\"mw-redirect\" title=\"University of Wisconsin\" rel=\"external_link\" target=\"_blank\">University of Wisconsin<\/a>. 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Applied+Neurophysiology&rft.atitle=Brown-Roberts-Wells+stereotactic+frame+modifications+to+accomplish+magnetic+resonance+imaging+guidance+in+three+planes&rft.volume=50&rft.issue=1%E2%80%936&rft.pages=143-52&rft.date=1987&rft_id=info%3Adoi%2F10.1159%2F000100700&rft_id=info%3Apmid%2F3329837&rft.aulast=Heilbrun&rft.aufirst=MP&rft.au=Sunderland%2C+PM&rft.au=McDonald%2C+PR&rft.au=Wells%2C+TH&rft.au=Cosman%2C+E&rft.au=Ganz%2C+E&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\"ACCF\/ACR\/SCCT\/SCMR\/ASNC\/NASCI\/SCAI\/SIR 2006 appropriateness criteria 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A report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group\". <i>Journal of the American College of Radiology<\/i>. <b>3<\/b> (10): 751\u201371. October 2006. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jacr.2006.08.008\" target=\"_blank\">10.1016\/j.jacr.2006.08.008<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17412166\" target=\"_blank\">17412166<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+American+College+of+Radiology&rft.atitle=ACCF%2FACR%2FSCCT%2FSCMR%2FASNC%2FNASCI%2FSCAI%2FSIR+2006+appropriateness+criteria+for+cardiac+computed+tomography+and+cardiac+magnetic+resonance+imaging.+A+report+of+the+American+College+of+Cardiology+Foundation+Quality+Strategic+Directions+Committee+Appropriateness+Criteria+Working+Group&rft.volume=3&rft.issue=10&rft.pages=751-71&rft.date=2006-10&rft_id=info%3Adoi%2F10.1016%2Fj.jacr.2006.08.008&rft_id=info%3Apmid%2F17412166&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Helms C (2008). <i>Musculoskeletal MRI<\/i>. Saunders. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-4160-5534-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Musculoskeletal+MRI&rft.pub=Saunders&rft.date=2008&rft.isbn=978-1-4160-5534-1&rft.aulast=Helms&rft.aufirst=C&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-FrydrychowiczLubner2012-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-FrydrychowiczLubner2012_24-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Frydrychowicz A, Lubner MG, Brown JJ, Merkle EM, Nagle SK, Rofsky NM, Reeder SB (March 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3281562\" target=\"_blank\">\"Hepatobiliary MR imaging with gadolinium-based contrast agents\"<\/a>. <i>Journal of Magnetic Resonance Imaging<\/i>. <b>35<\/b> (3): 492\u2013511. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fjmri.22833\" target=\"_blank\">10.1002\/jmri.22833<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3281562\" target=\"_blank\">3281562<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22334493\" target=\"_blank\">22334493<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Magnetic+Resonance+Imaging&rft.atitle=Hepatobiliary+MR+imaging+with+gadolinium-based+contrast+agents&rft.volume=35&rft.issue=3&rft.pages=492-511&rft.date=2012-03&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3281562&rft_id=info%3Apmid%2F22334493&rft_id=info%3Adoi%2F10.1002%2Fjmri.22833&rft.aulast=Frydrychowicz&rft.aufirst=A&rft.au=Lubner%2C+MG&rft.au=Brown%2C+JJ&rft.au=Merkle%2C+EM&rft.au=Nagle%2C+SK&rft.au=Rofsky%2C+NM&rft.au=Reeder%2C+SB&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3281562&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-SandrasegaranLin2010-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-SandrasegaranLin2010_25-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sandrasegaran K, Lin C, Akisik FM, Tann M (July 2010). \"State-of-the-art pancreatic MRI\". <i>AJR. American Journal of Roentgenology<\/i>. <b>195<\/b> (1): 42\u201353. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2214%2Fajr.195.3_supplement.0s42\" target=\"_blank\">10.2214\/ajr.195.3_supplement.0s42<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20566796\" target=\"_blank\">20566796<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AJR.+American+Journal+of+Roentgenology&rft.atitle=State-of-the-art+pancreatic+MRI&rft.volume=195&rft.issue=1&rft.pages=42-53&rft.date=2010-07&rft_id=info%3Adoi%2F10.2214%2Fajr.195.3_supplement.0s42&rft_id=info%3Apmid%2F20566796&rft.aulast=Sandrasegaran&rft.aufirst=K&rft.au=Lin%2C+C&rft.au=Akisik%2C+FM&rft.au=Tann%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MasselliGualdi2012-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MasselliGualdi2012_26-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Masselli G, Gualdi G (August 2012). \"MR imaging of the small bowel\". <i>Radiology<\/i>. <b>264<\/b> (2): 333\u201348. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1148%2Fradiol.12111658\" target=\"_blank\">10.1148\/radiol.12111658<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22821694\" target=\"_blank\">22821694<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Radiology&rft.atitle=MR+imaging+of+the+small+bowel&rft.volume=264&rft.issue=2&rft.pages=333-48&rft.date=2012-08&rft_id=info%3Adoi%2F10.1148%2Fradiol.12111658&rft_id=info%3Apmid%2F22821694&rft.aulast=Masselli&rft.aufirst=G&rft.au=Gualdi%2C+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ZijtaBipat2009-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ZijtaBipat2009_27-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Zijta FM, Bipat S, Stoker J (May 2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2850516\" target=\"_blank\">\"Magnetic resonance (MR) colonography in the detection of colorectal lesions: a systematic review of prospective studies\"<\/a>. <i>European Radiology<\/i>. <b>20<\/b> (5): 1031\u201346. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00330-009-1663-4\" target=\"_blank\">10.1007\/s00330-009-1663-4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2850516\" target=\"_blank\">2850516<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19936754\" target=\"_blank\">19936754<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Radiology&rft.atitle=Magnetic+resonance+%28MR%29+colonography+in+the+detection+of+colorectal+lesions%3A+a+systematic+review+of+prospective+studies&rft.volume=20&rft.issue=5&rft.pages=1031-46&rft.date=2010-05&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2850516&rft_id=info%3Apmid%2F19936754&rft_id=info%3Adoi%2F10.1007%2Fs00330-009-1663-4&rft.aulast=Zijta&rft.aufirst=FM&rft.au=Bipat%2C+S&rft.au=Stoker%2C+J&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2850516&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-haacke-28\"><span class=\"mw-cite-backlink\"><b><a 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href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23335551\" target=\"_blank\">23335551<\/a>.<\/cite><span 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rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Liu CH, Kim YR, Ren JQ, Eichler F, Rosen BR, Liu PK (January 2007). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2647966\" target=\"_blank\">\"Imaging cerebral gene transcripts in live animals\"<\/a>. <i>The Journal of Neuroscience<\/i>. <b>27<\/b> (3): 713\u201322. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1523%2FJNEUROSCI.4660-06.2007\" target=\"_blank\">10.1523\/JNEUROSCI.4660-06.2007<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2647966\" target=\"_blank\">2647966<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17234603\" target=\"_blank\">17234603<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Neuroscience&rft.atitle=Imaging+cerebral+gene+transcripts+in+live+animals&rft.volume=27&rft.issue=3&rft.pages=713-22&rft.date=2007-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2647966&rft_id=info%3Apmid%2F17234603&rft_id=info%3Adoi%2F10.1523%2FJNEUROSCI.4660-06.2007&rft.aulast=Liu&rft.aufirst=CH&rft.au=Kim%2C+YR&rft.au=Ren%2C+JQ&rft.au=Eichler%2C+F&rft.au=Rosen%2C+BR&rft.au=Liu%2C+PK&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2647966&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid24115049-80\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid24115049_80-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Liu CH, Ren J, Liu CM, Liu PK (January 2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3868842\" target=\"_blank\">\"Intracellular gene transcription factor protein-guided MRI by DNA aptamers in vivo\"<\/a>. <i>FASEB Journal<\/i>. <b>28<\/b> (1): 464\u201373. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1096%2Ffj.13-234229\" target=\"_blank\">10.1096\/fj.13-234229<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3868842\" target=\"_blank\">3868842<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24115049\" target=\"_blank\">24115049<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=FASEB+Journal&rft.atitle=Intracellular+gene+transcription+factor+protein-guided+MRI+by+DNA+aptamers+in+vivo&rft.volume=28&rft.issue=1&rft.pages=464-73&rft.date=2014-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3868842&rft_id=info%3Apmid%2F24115049&rft_id=info%3Adoi%2F10.1096%2Ffj.13-234229&rft.aulast=Liu&rft.aufirst=CH&rft.au=Ren%2C+J&rft.au=Liu%2C+CM&rft.au=Liu%2C+PK&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3868842&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid19295156-81\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid19295156_81-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Liu CH, You Z, Liu CM, Kim YR, Whalen MJ, Rosen BR, Liu PK (March 2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2726707\" target=\"_blank\">\"Diffusion-weighted magnetic resonance imaging reversal by gene knockdown of matrix metalloproteinase-9 activities in live animal brains\"<\/a>. <i>The Journal of Neuroscience<\/i>. <b>29<\/b> (11): 3508\u201317. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1523%2FJNEUROSCI.5332-08.2009\" target=\"_blank\">10.1523\/JNEUROSCI.5332-08.2009<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2726707\" target=\"_blank\">2726707<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19295156\" target=\"_blank\">19295156<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Neuroscience&rft.atitle=Diffusion-weighted+magnetic+resonance+imaging+reversal+by+gene+knockdown+of+matrix+metalloproteinase-9+activities+in+live+animal+brains&rft.volume=29&rft.issue=11&rft.pages=3508-17&rft.date=2009-03&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2726707&rft_id=info%3Apmid%2F19295156&rft_id=info%3Adoi%2F10.1523%2FJNEUROSCI.5332-08.2009&rft.aulast=Liu&rft.aufirst=CH&rft.au=You%2C+Z&rft.au=Liu%2C+CM&rft.au=Kim%2C+YR&rft.au=Whalen%2C+MJ&rft.au=Rosen%2C+BR&rft.au=Liu%2C+PK&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2726707&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid23150521-82\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid23150521_82-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Liu CH, Yang J, Ren JQ, Liu CM, You Z, Liu PK (February 2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3545538\" target=\"_blank\">\"MRI reveals differential effects of amphetamine exposure on neuroglia in vivo\"<\/a>. <i>FASEB Journal<\/i>. <b>27<\/b> (2): 712\u201324. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1096%2Ffj.12-220061\" target=\"_blank\">10.1096\/fj.12-220061<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3545538\" target=\"_blank\">3545538<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23150521\" target=\"_blank\">23150521<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=FASEB+Journal&rft.atitle=MRI+reveals+differential+effects+of+amphetamine+exposure+on+neuroglia+in+vivo&rft.volume=27&rft.issue=2&rft.pages=712-24&rft.date=2013-02&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3545538&rft_id=info%3Apmid%2F23150521&rft_id=info%3Adoi%2F10.1096%2Ffj.12-220061&rft.aulast=Liu&rft.aufirst=CH&rft.au=Yang%2C+J&rft.au=Ren%2C+JQ&rft.au=Liu%2C+CM&rft.au=You%2C+Z&rft.au=Liu%2C+PK&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3545538&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-83\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-83\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131203002732\/http:\/\/www.official-documents.gov.uk\/document\/hc1011\/hc08\/0822\/0822.pdf\" target=\"_blank\">\"Managing high value capital equipment in the NHS in England\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Audit_Office_(United_Kingdom)\" title=\"National Audit Office (United Kingdom)\" rel=\"external_link\" target=\"_blank\">National Audit Office (United Kingdom)<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.official-documents.gov.uk\/document\/hc1011\/hc08\/0822\/0822.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 3 December 2013<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">30 November<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Managing+high+value+capital+equipment+in+the+NHS+in+England&rft.pub=National+Audit+Office+%28United+Kingdom%29&rft_id=http%3A%2F%2Fwww.official-documents.gov.uk%2Fdocument%2Fhc1011%2Fhc08%2F0822%2F0822.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-84\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-84\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ed.nl\/economie\/philips\/mri-scanner-kassucces-voor-philips-1.2172462\" target=\"_blank\">\"MRI-scanner big financial success for Philips (Dutch)\"<\/a>. Eindhovens Dagblad (ED)<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">18 February<\/span> 2009<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=MRI-scanner+big+financial+success+for+Philips+%28Dutch%29&rft.pub=Eindhovens+Dagblad+%28ED%29&rft_id=http%3A%2F%2Fwww.ed.nl%2Feconomie%2Fphilips%2Fmri-scanner-kassucces-voor-philips-1.2172462&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-85\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-85\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150904002346\/http:\/\/medischcontact.artsennet.nl\/actueel\/nieuws\/nieuwsartikel\/21265\/mriscanner-van-7-miljoen-in-gebruik.htm\" target=\"_blank\">\"MRI scanner of \u20ac7 million in use(Dutch)\"<\/a>. Medisch Contact. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/medischcontact.artsennet.nl\/actueel\/nieuws\/nieuwsartikel\/21265\/mriscanner-van-7-miljoen-in-gebruik.htm\" target=\"_blank\">the original<\/a> on 4 September 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 December<\/span> 2007<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=MRI+scanner+of+%E2%82%AC7+million+in+use%28Dutch%29&rft.pub=Medisch+Contact&rft_id=http%3A%2F%2Fmedischcontact.artsennet.nl%2Factueel%2Fnieuws%2Fnieuwsartikel%2F21265%2Fmriscanner-van-7-miljoen-in-gebruik.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-MorganConolly1996-86\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MorganConolly1996_86-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Morgan P, Conolly S, Scott G, Macovski A (October 1996). \"A readout magnet for prepolarized MRI\". <i>Magnetic Resonance in Medicine<\/i>. <b>36<\/b> (4): 527\u201336. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fmrm.1910360405\" target=\"_blank\">10.1002\/mrm.1910360405<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8892203\" target=\"_blank\">8892203<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Magnetic+Resonance+in+Medicine&rft.atitle=A+readout+magnet+for+prepolarized+MRI&rft.volume=36&rft.issue=4&rft.pages=527-36&rft.date=1996-10&rft_id=info%3Adoi%2F10.1002%2Fmrm.1910360405&rft_id=info%3Apmid%2F8892203&rft.aulast=Morgan&rft.aufirst=P&rft.au=Conolly%2C+S&rft.au=Scott%2C+G&rft.au=Macovski%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Blamire2008-87\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Blamire2008_87-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Blamire AM (August 2008). \"The technology of MRI--the next 10 years?\". <i>The British Journal of Radiology<\/i>. <b>81<\/b> (968): 601\u201317. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1259%2Fbjr%2F96872829\" target=\"_blank\">10.1259\/bjr\/96872829<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18628329\" target=\"_blank\">18628329<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+British+Journal+of+Radiology&rft.atitle=The+technology+of+MRI--the+next+10+years%3F&rft.volume=81&rft.issue=968&rft.pages=601-17&rft.date=2008-08&rft_id=info%3Adoi%2F10.1259%2Fbjr%2F96872829&rft_id=info%3Apmid%2F18628329&rft.aulast=Blamire&rft.aufirst=AM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-88\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-88\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Stamford Hospital price quotation October 2008, Stamford CT US<\/span>\n<\/li>\n<li id=\"cite_note-89\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-89\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation conference\">Goldstein WM, Gordon AC, Branson JJ, Simmons C, Berland K, Willsey DS, Andrews AL (March 5\u20139, 2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20150904002346\/http:\/\/www.ibji.com\/images\/lyftenbloggie\/poster_goldstein_2008aaos.pdf\" target=\"_blank\"><i>Over-Utilization of MRI in the Osteoarthritis Patient<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>. Annual Meeting AAOS. San Francisco. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ibji.com\/images\/lyftenbloggie\/poster_goldstein_2008aaos.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2015-09-04<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-07-27<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=conference&rft.btitle=Over-Utilization+of+MRI+in+the+Osteoarthritis+Patient&rft.place=San+Francisco&rft.date=2008-03-05%2F2008-03-09&rft.aulast=Goldstein&rft.aufirst=Wayne+M.&rft.au=Gordon%2C+Alexander+C.&rft.au=Branson%2C+Jill+Jasperson&rft.au=Simmons%2C+Christopher&rft.au=Berland%2C+Kimberly&rft.au=Willsey%2C+Daniel+S.&rft.au=Andrews%2C+Amanda+L.&rft_id=http%3A%2F%2Fwww.ibji.com%2Fimages%2Flyftenbloggie%2Fposter_goldstein_2008aaos.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-90\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-90\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Current_Procedural_Terminology\" title=\"Current Procedural Terminology\" rel=\"external_link\" target=\"_blank\">Current Procedural Terminology<\/a> code #70553 <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/explore.data.gov\/Health-and-Nutrition\/Part-B-National-Summary-Data-File-CY2010\/5vgw-8z3q\" target=\"_blank\">\"2010 Medicare Part B National Summary Data File\"<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120214030717\/http:\/\/explore.data.gov\/Health-and-Nutrition\/Part-B-National-Summary-Data-File-CY2010\/5vgw-8z3q\" target=\"_blank\">Archived<\/a> 2012-02-14 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.. Data.gov, An Official Website of the United States Government.<\/span>\n<\/li>\n<li id=\"cite_note-91\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-91\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.webmd.com\/multiple-sclerosis\/qa\/how-long-does-an-mri-take\" target=\"_blank\">\"How long does an MRI take?\"<\/a>. <i>WebMD.com<\/i>. 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American Journal of Roentgenology<\/i>. <b>191<\/b> (2): 328\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2214%2FAJR.07.3940\" target=\"_blank\">10.2214\/AJR.07.3940<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18647897\" target=\"_blank\">18647897<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AJR.+American+Journal+of+Roentgenology&rft.atitle=Radiology+in+Japan+in+2008&rft.volume=191&rft.issue=2&rft.pages=328-9&rft.date=2008-08&rft_id=info%3Adoi%2F10.2214%2FAJR.07.3940&rft_id=info%3Apmid%2F18647897&rft.aulast=Ehara&rft.aufirst=S&rft.au=Nakajima%2C+Y&rft.au=Matsui%2C+O&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-93\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-93\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.fairfield.org.uk\/tests\/private-mri-scan\/\" target=\"_blank\">\"Private MRI Scan\"<\/a>. <i>Fairfield.org.uk<\/i>. 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American Journal of Roentgenology<\/i>. <b>198<\/b> (4): 778\u201384. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2214%2FAJR.11.7405\" target=\"_blank\">10.2214\/AJR.11.7405<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22451541\" target=\"_blank\">22451541<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AJR.+American+Journal+of+Roentgenology&rft.atitle=Imaging+of+pregnant+and+lactating+patients%3A+part+1%2C+evidence-based+review+and+recommendations&rft.volume=198&rft.issue=4&rft.pages=778-84&rft.date=2012-04&rft_id=info%3Adoi%2F10.2214%2FAJR.11.7405&rft_id=info%3Apmid%2F22451541&rft.aulast=Wang&rft.aufirst=PI&rft.au=Chong%2C+ST&rft.au=Kielar%2C+AZ&rft.au=Kelly%2C+AM&rft.au=Knoepp%2C+UD&rft.au=Mazza%2C+MB&rft.au=Goodsitt%2C+MM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-iRefer-96\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-iRefer_96-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.rcr.ac.uk\/content.aspx?PageID=995\" target=\"_blank\">\"iRefer\"<\/a>. 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Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/consumerhealthchoices.org\/wp-content\/uploads\/2012\/04\/High-Value-Care-Back-Pain-ACP.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 15 January 2013<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">August 14,<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=High+Value+Care&rft.atitle=Imaging+tests+for+lower-back+pain%3A+Why+you+probably+don%27t+need+them&rft.date=2012-04&rft.au=Consumer+Reports&rft.au=American+College+of+Physicians&rft_id=http%3A%2F%2Fconsumerhealthchoices.org%2Fwp-content%2Fuploads%2F2012%2F04%2FHigh-Value-Care-Back-Pain-ACP.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ErasmusHurter2004-101\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ErasmusHurter2004_101-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ErasmusHurter2004_101-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Erasmus LJ, Hurter D, Naude M, Kritzinger HG, Acho S (2004). \"A short overview of MRI artefacts\". <i>South African Journal of Radiology<\/i>. <b>8<\/b> (2): 13. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4102%2Fsajr.v8i2.127\" target=\"_blank\">10.4102\/sajr.v8i2.127<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=South+African+Journal+of+Radiology&rft.atitle=A+short+overview+of+MRI+artefacts&rft.volume=8&rft.issue=2&rft.pages=13&rft.date=2004&rft_id=info%3Adoi%2F10.4102%2Fsajr.v8i2.127&rft.aulast=Erasmus&rft.aufirst=LJ&rft.au=Hurter%2C+D&rft.au=Naude%2C+M&rft.au=Kritzinger%2C+HG&rft.au=Acho%2C+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-non-medical-102\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-non-medical_102-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Rinck PA (2017). \"Chapter Nineteen Non-Medical Applications of NMR and MRI\". <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.magnetic-resonance.org\/ch\/19-01.html\" target=\"_blank\"><i>Magnetic Resonance<\/i><\/a> (11th ed.)<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-12-18<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Chapter+Nineteen+Non-Medical+Applications+of+NMR+and+MRI&rft.btitle=Magnetic+Resonance&rft.edition=11th&rft.date=2017&rft.aulast=Rinck&rft.aufirst=PA&rft_id=http%3A%2F%2Fwww.magnetic-resonance.org%2Fch%2F19-01.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-103\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-103\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rinck PA (2008). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.spectroscopyeurope.com\/article\/short-history-magnetic-resonance-imaging\" target=\"_blank\">\"A short history of magnetic resonance imaging\"<\/a>. <i>Spectroscopy Europe<\/i>. <b>20<\/b> (1): 7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Spectroscopy+Europe&rft.atitle=A+short+history+of+magnetic+resonance+imaging&rft.volume=20&rft.issue=1&rft.pages=7&rft.date=2008&rft.aulast=Rinck&rft.aufirst=PA&rft_id=https%3A%2F%2Fwww.spectroscopyeurope.com%2Farticle%2Fshort-history-magnetic-resonance-imaging&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Mansfield-EPI-104\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Mansfield-EPI_104-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mansfield P, Grannell PK (1975). \"<span class=\"cs1-kern-left\">\"<\/span>Diffraction\" and microscopy in solids and liquids by NMR\". <i>Physical Review B<\/i>. <b>12<\/b> (9): 3618\u20133634. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1103%2Fphysrevb.12.3618\" target=\"_blank\">10.1103\/physrevb.12.3618<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Physical+Review+B&rft.atitle=%22Diffraction%22+and+microscopy+in+solids+and+liquids+by+NMR&rft.volume=12&rft.issue=9&rft.pages=3618-3634&rft.date=1975&rft_id=info%3Adoi%2F10.1103%2Fphysrevb.12.3618&rft.aulast=Mansfield&rft.aufirst=P&rft.au=Grannell%2C+PK&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<div class=\"refbegin columns references-column-width\" style=\"-moz-column-width: 32em; -webkit-column-width: 32em; column-width: 32em;\">\n<ul><li><cite class=\"citation web\">Rinck PA (ed.). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.magnetic-resonance.org\/ch\/20-01.html\" target=\"_blank\">\"The history of MRI\"<\/a>. <i>TRTF\/EMRF<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=TRTF%2FEMRF&rft.atitle=The+history+of+MRI&rft_id=http%3A%2F%2Fwww.magnetic-resonance.org%2Fch%2F20-01.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Eustace SJ, Nelson E (June 2004). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC421763\" target=\"_blank\">\"Whole body magnetic resonance imaging\"<\/a>. <i>BMJ<\/i>. <b>328<\/b> (7453): 1387\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmj.328.7453.1387\" target=\"_blank\">10.1136\/bmj.328.7453.1387<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC421763\" target=\"_blank\">421763<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15191954\" target=\"_blank\">15191954<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMJ&rft.atitle=Whole+body+magnetic+resonance+imaging&rft.volume=328&rft.issue=7453&rft.pages=1387-8&rft.date=2004-06&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC421763&rft_id=info%3Apmid%2F15191954&rft_id=info%3Adoi%2F10.1136%2Fbmj.328.7453.1387&rft.aulast=Eustace&rft.aufirst=SJ&rft.au=Nelson%2C+E&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC421763&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Pykett IL (May 1982). \"NMR imaging in medicine\". <i>Scientific American<\/i>. <b>246<\/b> (5): 78\u201388. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1038%2Fscientificamerican0582-78\" target=\"_blank\">10.1038\/scientificamerican0582-78<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7079720\" target=\"_blank\">7079720<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Scientific+American&rft.atitle=NMR+imaging+in+medicine&rft.volume=246&rft.issue=5&rft.pages=78-88&rft.date=1982-05&rft_id=info%3Adoi%2F10.1038%2Fscientificamerican0582-78&rft_id=info%3Apmid%2F7079720&rft.aulast=Pykett&rft.aufirst=IL&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Simon M, Mattson JS (1996). <i>The pioneers of NMR and magnetic resonance in medicine: The story of MRI<\/i>. Ramat Gan, Israel: Bar-Ilan University Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-9619243-1-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+pioneers+of+NMR+and+magnetic+resonance+in+medicine%3A+The+story+of+MRI&rft.place=Ramat+Gan%2C+Israel&rft.pub=Bar-Ilan+University+Press&rft.date=1996&rft.isbn=978-0-9619243-1-7&rft.aulast=Simon&rft.aufirst=Merrill&rft.au=Mattson%2C+James+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Haacke EM, Brown RF, Thompson M, Venkatesan R (1999). <i>Magnetic resonance imaging: Physical principles and sequence design<\/i>. New York: J. Wiley & Sons. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-471-35128-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Magnetic+resonance+imaging%3A+Physical+principles+and+sequence+design&rft.place=New+York&rft.pub=J.+Wiley+%26+Sons&rft.date=1999&rft.isbn=978-0-471-35128-3&rft.aulast=Haacke&rft.aufirst=E+Mark&rft.au=Brown%2C+Robert+F&rft.au=Thompson%2C+Michael&rft.au=Venkatesan%2C+Ramesh&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Lee SC, Kim K, Kim J, Lee S, Han Yi J, Kim SW, Ha KS, Cheong C (June 2001). \"One micrometer resolution NMR microscopy\". <i>Journal of Magnetic Resonance<\/i>. <b>150<\/b> (2): 207\u201313. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1006%2Fjmre.2001.2319\" target=\"_blank\">10.1006\/jmre.2001.2319<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11384182\" target=\"_blank\">11384182<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Magnetic+Resonance&rft.atitle=One+micrometer+resolution+NMR+microscopy&rft.volume=150&rft.issue=2&rft.pages=207-13&rft.date=2001-06&rft_id=info%3Adoi%2F10.1006%2Fjmre.2001.2319&rft_id=info%3Apmid%2F11384182&rft.aulast=Lee&rft.aufirst=SC&rft.au=Kim%2C+K&rft.au=Kim%2C+J&rft.au=Lee%2C+S&rft.au=Han+Yi%2C+J&rft.au=Kim%2C+SW&rft.au=Ha%2C+KS&rft.au=Cheong%2C+C&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Sprawls P (2000). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sprawls.org\/mripmt\/index.html\" target=\"_blank\"><i>Magnetic Resonance Imaging <sub>Principles, Methods, and Techniques<\/sub><\/i><\/a>. Medical Physics Publishing. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-944838-97-6.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Magnetic+Resonance+Imaging+%3Csub%3EPrinciples%2C+Methods%2C+and+Techniques%3C%2Fsub%3E&rft.pub=Medical+Physics+Publishing&rft.date=2000&rft.isbn=978-0-944838-97-6&rft.aulast=Sprawls&rft.aufirst=Perry&rft_id=http%3A%2F%2Fwww.sprawls.org%2Fmripmt%2Findex.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Mansfield P (1982). <i>NMR Imaging in Biomedicine: Supplement 2 Advances in Magnetic Resonance<\/i>. Elsevier. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-323-15406-2.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=NMR+Imaging+in+Biomedicine%3A+Supplement+2+Advances+in+Magnetic+Resonance&rft.pub=Elsevier&rft.date=1982&rft.isbn=978-0-323-15406-2&rft.aulast=Mansfield&rft.aufirst=P&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Fukushima E (1989). <i>NMR in Biomedicine: The Physical Basis<\/i>. Springer Science & Business Media. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-88318-609-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=NMR+in+Biomedicine%3A+The+Physical+Basis&rft.pub=Springer+Science+%26+Business+Media&rft.date=1989&rft.isbn=978-0-88318-609-1&rft.aulast=Fukushima&rft.aufirst=Eiichi&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Bl\u00fcmich B, Kuhn W (1992). <i>Magnetic Resonance Microscopy: Methods and Applications in Materials Science, Agriculture and Biomedicine<\/i>. Wiley. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-527-28403-0.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Magnetic+Resonance+Microscopy%3A+Methods+and+Applications+in+Materials+Science%2C+Agriculture+and+Biomedicine&rft.pub=Wiley&rft.date=1992&rft.isbn=978-3-527-28403-0&rft.aulast=Bl%C3%BCmich&rft.aufirst=Bernhard&rft.au=Kuhn%2C+Winfried&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Bl\u00fcmer P (1998). Bl\u00fcmler P, Bl\u00fcmich B, Botto RE, Fukushima E, eds. <i>Spatially Resolved Magnetic Resonance: Methods, Materials, Medicine, Biology, Rheology, Geology, Ecology, Hardware<\/i>. Wiley-VCH. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-527-29637-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Spatially+Resolved+Magnetic+Resonance%3A+Methods%2C+Materials%2C+Medicine%2C+Biology%2C+Rheology%2C+Geology%2C+Ecology%2C+Hardware&rft.pub=Wiley-VCH&rft.date=1998&rft.isbn=978-3-527-29637-8&rft.aulast=Bl%C3%BCmer&rft.aufirst=Peter&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Liang Z, Lauterbur PC (1999). <i>Principles of Magnetic Resonance Imaging: A Signal Processing Perspective<\/i>. Wiley. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-7803-4723-6.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Principles+of+Magnetic+Resonance+Imaging%3A+A+Signal+Processing+Perspective&rft.pub=Wiley&rft.date=1999&rft.isbn=978-0-7803-4723-6&rft.aulast=Liang&rft.aufirst=Zhi-Pei&rft.au=Lauterbur%2C+Paul+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Schmitt F, Stehling MK, Turner R (1998). <i>Echo-Planar Imaging: Theory, Technique and Application<\/i>. Springer Berlin Heidelberg. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-540-63194-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Echo-Planar+Imaging%3A+Theory%2C+Technique+and+Application&rft.pub=Springer+Berlin+Heidelberg&rft.date=1998&rft.isbn=978-3-540-63194-1&rft.aulast=Schmitt&rft.aufirst=Franz&rft.au=Stehling%2C+Michael+K.&rft.au=Turner%2C+Robert&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Kuperman V (2000). <i>Magnetic Resonance Imaging: Physical Principles and Applications<\/i>. Academic Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-08-053570-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Magnetic+Resonance+Imaging%3A+Physical+Principles+and+Applications&rft.pub=Academic+Press&rft.date=2000&rft.isbn=978-0-08-053570-8&rft.aulast=Kuperman&rft.aufirst=Vadim&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Bl\u00fcmich B (2000). <i>NMR Imaging of Materials<\/i>. Clarendon Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-19-850683-6.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=NMR+Imaging+of+Materials&rft.pub=Clarendon+Press&rft.date=2000&rft.isbn=978-0-19-850683-6&rft.aulast=Bl%C3%BCmich&rft.aufirst=Bernhard&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Jin J (1998). <i>Electromagnetic Analysis and Design in Magnetic Resonance Imaging<\/i>. CRC Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-8493-9693-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Electromagnetic+Analysis+and+Design+in+Magnetic+Resonance+Imaging&rft.pub=CRC+Press&rft.date=1998&rft.isbn=978-0-8493-9693-9&rft.aulast=Jin&rft.aufirst=Jianming&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Farhat IA, Belton PS, Webb GA (2007). <i>Magnetic Resonance in Food Science: From Molecules to Man<\/i>. Royal Society of Chemistry. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-85404-340-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Magnetic+Resonance+in+Food+Science%3A+From+Molecules+to+Man&rft.pub=Royal+Society+of+Chemistry&rft.date=2007&rft.isbn=978-0-85404-340-8&rft.aulast=Farhat&rft.aufirst=Imad+Akil&rft.au=Belton%2C+P.+S.&rft.au=Webb%2C+Graham+Alan&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n\n<ul><li><cite class=\"citation web\">Rinck PA (ed.). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.magnetic-resonance.org\" target=\"_blank\">\"MRI: A Peer-Reviewed, Critical Introduction\"<\/a>. <i>European Magnetic Resonance Forum (EMRF)\/The Round Table Foundation (TRTF)<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=European+Magnetic+Resonance+Forum+%28EMRF%29%2FThe+Round+Table+Foundation+%28TRTF%29&rft.atitle=MRI%3A+A+Peer-Reviewed%2C+Critical+Introduction&rft_id=http%3A%2F%2Fwww.magnetic-resonance.org&rfr_id=info%3Asid%2Fen.wikipedia.org%3AMagnetic+resonance+imaging\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/nationalmaglab.org\/education\/magnet-academy\/learn-the-basics\/stories\/mri-a-guided-tour\" target=\"_blank\">A Guided Tour of MRI: An introduction for laypeople<\/a> National High Magnetic Field Laboratory<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cis.rit.edu\/htbooks\/mri\/\" target=\"_blank\">The Basics of MRI<\/a>. <i>Underlying physics and technical aspects<\/i>.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.imrser.org\/PatientVideo.html\" target=\"_blank\">Video: What to Expect During Your MRI Exam<\/a> from the Institute for Magnetic Resonance Safety, Education, and Research (IMRSER)<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.vega.org.uk\/video\/programme\/73\" target=\"_blank\">Royal Institution Lecture \u2013 MRI: A Window on the Human Body<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070413032705\/http:\/\/www.emrf.org\/FAQs%20MRI%20History.html\" target=\"_blank\">A SHORT HISTORY OF MAGNETIC RESONANCE IMAGING FROM A EUROPEAN POINT OF VIEW<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/aidb.crbs.ucsd.edu\/sand\/index.jsp\" target=\"_blank\"><sup class=\"noprint Inline-Template\"><span style=\"white-space: nowrap;\">[<\/span><\/sup><\/a><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Link_rot\" title=\"Wikipedia:Link rot\" rel=\"external_link\" target=\"_blank\"><span title=\" Dead link since July 2018\">permanent dead link<\/span><\/a><\/i>] Animal Imaging Database (AIDB)<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.howequipmentworks.com\/physics\/medical_imaging\/mri\/magnetic_resonance_imaging.html\" target=\"_blank\">How MRI works explained simply using diagrams<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.biomednmr.mpg.de\/index.php?option=com_content&task=view&id=132&Itemid=39\" target=\"_blank\">Real-time MRI videos: Biomedizinische NMR Forschungs GmbH<\/a>.<\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1249\nCached time: 20181217050855\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.604 seconds\nReal time usage: 1.847 seconds\nPreprocessor visited node count: 7256\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 308864\/2097152 bytes\nTemplate argument size: 5772\/2097152 bytes\nHighest expansion depth: 14\/40\nExpensive parser function count: 15\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 322566\/5000000 bytes\nNumber of Wikibase entities loaded: 5\/400\nLua time usage: 0.950\/10.000 seconds\nLua memory usage: 7.54 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1496.871 1 -total\n<\/p>\n<pre>58.50% 875.603 1 Template:Reflist\n28.17% 421.602 51 Template:Cite_journal\n13.93% 208.467 42 Template:Cite_web\n12.37% 185.148 24 Template:Cite_book\n 8.28% 123.960 9 Template:Fix\n 7.14% 106.924 6 Template:Citation_needed\n 4.63% 69.271 1 Template:Commons_category\n 4.01% 59.952 8 Template:Delink\n 3.87% 57.867 1 Template:Commons\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:19446-1!canonical and timestamp 20181217050853 and revision id 873528501\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214704\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.034 seconds\nReal time usage: 0.240 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 222.565 1 - wikipedia:Magnetic_resonance_imaging\n100.00% 222.565 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8569-0!*!*!*!*!*!* and timestamp 20181217214704 and revision id 24997\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Magnetic_resonance_imaging\">https:\/\/www.limswiki.org\/index.php\/Magnetic_resonance_imaging<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","ecf92fce38dc6c6fbe9e6feac471ffd2_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/62\/Mri_scanner_schematic_labelled.svg\/660px-Mri_scanner_schematic_labelled.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/4\/4d\/TR_TE.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/03\/T1t2PD.jpg\/440px-T1t2PD.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/55\/Siemens_Magnetom_Aera_MRI_scanner.jpg\/440px-Siemens_Magnetom_Aera_MRI_scanner.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/f2\/White_Matter_Connections_Obtained_with_MRI_Tractography.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/a\/ad\/PAPVR.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/38\/Mra1.jpg\/440px-Mra1.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/03\/T1-weighted-MRI.png\/200px-T1-weighted-MRI.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b7\/Normal_axial_T2-weighted_MR_image_of_the_brain.jpg\/200px-Normal_axial_T2-weighted_MR_image_of_the_brain.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Proton_density_MRI_of_a_grade_2_medial_meniscal_tear.jpg\/200px-Proton_density_MRI_of_a_grade_2_medial_meniscal_tear.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/7\/73\/Four_chamber_cardiovascular_magnetic_resonance_imaging.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/Effective_T2-weighted_MRI_of_hemosiderin_deposits_after_subarachnoid_hemorrhage.png\/200px-Effective_T2-weighted_MRI_of_hemosiderin_deposits_after_subarachnoid_hemorrhage.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Shinsplint-mri_%28crop%29.jpg\/140px-Shinsplint-mri_%28crop%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9b\/FLAIR_MRI_of_meningitis.jpg\/200px-FLAIR_MRI_of_meningitis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/ce\/Axial_DIR_MRI_of_a_brain_with_multiple_sclerosis_lesions.jpg\/200px-Axial_DIR_MRI_of_a_brain_with_multiple_sclerosis_lesions.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/Cerebral_infarction_after_4_hours_on_DWI_MRI.jpg\/200px-Cerebral_infarction_after_4_hours_on_DWI_MRI.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/f\/f3\/Cerebral_infarction_after_4_hours_on_ADC_MRI.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f2\/White_Matter_Connections_Obtained_with_MRI_Tractography.png\/200px-White_Matter_Connections_Obtained_with_MRI_Tractography.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/9\/9b\/Tmax_by_MRI_perfusion_in_cerebral_artery_occlusion.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/1206_FMRI.jpg\/200px-1206_FMRI.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/66\/Mra-mip.jpg\/200px-Mra-mip.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/26\/Vastly_undersampled_Isotropic_Projection_Reconstruction_%28VIPR%29_Phase_Contrast_%28PC%29_sequence_MRI_of_arterial_dissections.jpg\/200px-Vastly_undersampled_Isotropic_Projection_Reconstruction_%28VIPR%29_Phase_Contrast_%28PC%29_sequence_MRI_of_arterial_dissections.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/a\/a5\/Susceptibility_weighted_imaging_%28SWI%29_in_diffuse_axonal_injury.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bd\/Modern_3T_MRI.JPG\/440px-Modern_3T_MRI.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0b\/Wx_camera_1507509040946.jpg\/240px-Wx_camera_1507509040946.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Wx_camera_1507509050808.jpg\/135px-Wx_camera_1507509050808.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/91\/Wx_camera_1507512102648.jpg\/240px-Wx_camera_1507512102648.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1a\/Wx_camera_1507514479961.jpg\/135px-Wx_camera_1507514479961.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/aa\/MRI_with_motion_artifacts.jpg\/440px-MRI_with_motion_artifacts.jpg"],"ecf92fce38dc6c6fbe9e6feac471ffd2_timestamp":1545083224,"bc5b7003f9b6b64085881e0e1ffa3d21_type":"article","bc5b7003f9b6b64085881e0e1ffa3d21_title":"Laparoscopic surgery","bc5b7003f9b6b64085881e0e1ffa3d21_url":"https:\/\/www.limswiki.org\/index.php\/Laparoscopic_surgery","bc5b7003f9b6b64085881e0e1ffa3d21_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tLaparoscopic surgery\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tLaparoscopyIllustration of LaparoscopyICD-9-CM54.21MeSHD010535 OPS-301 code1-694[edit on Wikidata]\nLaparoscopy (from Ancient Greek  \u03bb\u03b1\u03c0\u03ac\u03c1\u03b1 (lapara), meaning 'flank, side', and  \u03c3\u03ba\u03bf\u03c0\u03ad\u03c9 (skopeo), meaning 'to see') is an operation performed in the abdomen or pelvis using small incisions (usually 0.5\u20131.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.[1]\nLaparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, or keyhole surgery, is a modern surgical technique. There are a number of advantages to the patient with laparoscopic surgery versus the more common, open procedure. These include reduced pain due to smaller incisions, reduced hemorrhaging and shorter recovery time. The key element is the use of a laparoscope, a long fiber optic cable system which allows viewing of the affected area by snaking the cable from a more distant, but more easily accessible location.\nLaparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Specific surgical instruments used in a laparoscopic surgery include forceps, scissors, probes, dissectors, hooks and retractors. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.\n\nContents \n\n1 Types \n2 Procedures \n\n2.1 Advantages \n2.2 Disadvantages \n2.3 Risks \n\n\n3 Robotic laparoscopic surgery \n4 Non-robotic hand guided assistance systems \n5 History \n6 Gynecological diagnosis \n7 See also \n8 References \n9 External links \n\n\nTypes \n Cholecystectomy as seen through a laparoscope\nThere are two types of laparoscope:[2]\n\na telescopic rod lens system, usually connected to a video camera (single chip or three chip)\na digital laparoscope where a miniature digital video camera is placed at the end of the laparoscope, eliminating the rod lens system\nThe mechanism mentioned in the second type is mainly used to improve the image quality of flexible endoscopes, replacing traditional fiberscopes. Nevertheless, laparoscopes are rigid endoscopes. The rigidity is required in clinical practice. The rod-lens based laparoscopes dominate overwhelmingly in practice, due to their fine optical resolution (50 \u00b5m typically, dependant on the aperture size used in the objective lens), and the image quality can be better than that of the digital camera if necessary. The second type of laparoscope is very rare in the laparoscope market and in hospitals.\nAlso attached is a fiber optic cable system connected to a \"cold\" light source (halogen or xenon), to illuminate the operative field, which is inserted through a 5 mm or 10 mm cannula or trocar. The abdomen is usually insufflated with carbon dioxide gas. This elevates the abdominal wall above the internal organs to create a working and viewing space. CO2 is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures.[3]\n\nProcedures \n Surgeons perform laparoscopic stomach surgery.\nLaparoscopic cholecystectomy is the most common laparoscopic procedure performed. In this procedure, 5\u201310 mm diameter instruments (graspers, scissors, clip applier) can be introduced by the surgeon into the abdomen through trocars (hollow tubes with a seal to keep the CO\r\n2 from leaking). Over one million cholecystectomies are performed in the U.S. annually, with over 96% of those being performed laparoscopically.\nRather than a minimum 20 cm incision as in traditional (open) cholecystectomy, four incisions of 0.5\u20131.0 cm, or more recently a single incision of 1.5\u20132.0 cm,[4] will be sufficient to perform a laparoscopic removal of a gallbladder. Since the gallbladder is similar to a small balloon that stores and releases bile, it can usually be removed from the abdomen by suctioning out the bile and then removing the deflated gallbladder through the 1 cm incision at the patient's navel. The length of postoperative stay in the hospital is minimal, and same-day discharges are possible in cases of early morning procedures.\nIn certain advanced laparoscopic procedures, where the size of the specimen being removed would be too large to pull out through a trocar site (as would be done with a gallbladder), an incision larger than 10 mm must be made. The most common of these procedures are removal of all or part of the colon (colectomy), or removal of the kidney (nephrectomy). Some surgeons perform these procedures completely laparoscopically, making the larger incision toward the end of the procedure for specimen removal, or, in the case of a colectomy, to also prepare the remaining healthy bowel to be reconnected (create an anastomosis). Many other surgeons feel that since they will have to make a larger incision for specimen removal anyway, they might as well use this incision to have their hand in the operative field during the procedure to aid as a retractor, dissector, and to be able to feel differing tissue densities (palpate), as they would in open surgery. This technique is called hand-assist laparoscopy. Since they will still be working with scopes and other laparoscopic instruments, CO2 will have to be maintained in the patient's abdomen, so a device known as a hand access port (a sleeve with a seal that allows passage of the hand) must be used. Surgeons who choose this hand-assist technique feel it reduces operative time significantly versus the straight laparoscopic approach. It also gives them more options in dealing with unexpected adverse events (e.g., uncontrolled bleeding) that may otherwise require creating a much larger incision and converting to a fully open surgical procedure.[citation needed ]\nConceptually, the laparoscopic approach is intended to minimise post-operative pain and speed up recovery times, while maintaining an enhanced visual field for surgeons. Due to improved patient outcomes, in the last two decades, laparoscopic surgery has been adopted by various surgical sub-specialties, including gastrointestinal surgery (including bariatric procedures for morbid obesity), gynecologic surgery, and urology. Based on numerous prospective randomized controlled trials, the approach has proven to be beneficial in reducing post-operative morbidities such as wound infections and incisional hernias (especially in morbidly obese patients), and is now deemed safe when applied to surgery for cancers such as cancer of colon.[citation needed ]\n\n Laparoscopic instruments.\nThe restricted vision, the difficulty in handling of the instruments (new hand-eye coordination skills are needed), the lack of tactile perception, and the limited working area are factors adding to the technical complexity of this surgical approach. For these reasons, minimally invasive surgery has emerged as a highly competitive new sub-specialty within various fields of surgery. Surgical residents who wish to focus on this area of surgery gain additional laparoscopic surgery training during one or two years of fellowship after completing their basic surgical residency. In OB-GYN residency programs, the average laparoscopy-to-laparotomy quotient (LPQ) is 0.55.\nThe first transatlantic surgery (Lindbergh operation) ever performed was a laparoscopic gallbladder removal.\nLaparoscopic techniques have also been developed in the field of veterinary medicine. Due to the relative high cost of the equipment required, however, it has not become commonplace in most traditional practices today but rather limited to specialty-type practices. Many of the same surgeries performed in humans can be applied to animal cases \u2013 everything from an egg-bound tortoise to a German Shepherd can benefit from MIS. A paper published in JAVMA (Journal of the American Veterinary Medical Association) in 2005 showed that dogs spayed laparoscopically experienced significantly less pain (65%) than those that were spayed with traditional \"open\" methods. Arthroscopy, thoracoscopy, cystoscopy are all performed in veterinary medicine today. The University of Georgia School of Veterinary Medicine and Colorado State University's School of Veterinary Medicine are two of the main centers where veterinary laparoscopy got started and have excellent training programs for veterinarians interested in getting started in MIS.[citation needed ]\n\nAdvantages \nThere are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include:This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2018) (Learn how and when to remove this template message)\nReduced hemorrhaging, which reduces the chance of needing a blood transfusion.\nSmaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.\nLess pain, leading to less pain medication needed.\nAlthough procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.\nReduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.\nThere are more indications for laparoscopic surgery in gastrointestinal emergencies as the field develops.[5]\nAlthough laparoscopy in adult age group is widely accepted, its advantages in pediatric age group is questioned. Benefits of laparoscopy appears to recede with younger age. Efficacy of laparoscopy is inferior to open surgery in certain conditions such as pyloromyotomy for Infantile hypertrophic pyloric stenosis. Although laparoscopic appendectomy has lesser wound problems than open surgery, the former is associated with more intra-abdominal abscesses.[6]\n\nDisadvantages \nWhile laparoscopic surgery is clearly advantageous in terms of patient outcomes, the procedure is more difficult from the surgeon's perspective when compared to traditional, open surgery:\n\nThe surgeon has a limited range of motion at the surgical site, resulting in a loss of dexterity.\nPoor depth perception.\nSurgeons must use tools to interact with tissue rather than manipulate it directly with their hands. This results in an inability to accurately judge how much force is being applied to tissue as well as a risk of damaging tissue by applying more force than necessary. This limitation also reduces tactile sensation, making it more difficult for the surgeon to feel tissue (sometimes an important diagnostic tool, such as when palpating for tumors) and making delicate operations such as tying sutures more difficult.[7]\nThe tool endpoints move in the opposite direction to the surgeon's hands due to the pivot point, making laparoscopic surgery a non-intuitive motor skill that is difficult to learn. This is called the fulcrum effect.[8]\nSome surgeries (carpal tunnel for instance) generally turn out better for the patient when the area can be opened up, allowing the surgeon to see \"the whole picture\" surrounding physiology, to better address the issue at hand. In this regard, keyhole surgery can be a disadvantage.[9]\nRisks \nSome of the risks are briefly described below:\n\nThe most significant risks are from trocar injuries during insertion into the abdominal cavity, as the trocar is typically inserted blindly. Injuries include abdominal wall hematoma, umbilical hernias, umbilical wound infection, and penetration of blood vessels or small or large bowel.[10]\nThe risk of such injuries is increased in patients who have a low body mass index[11] or have a history of prior abdominal surgery. While these injuries are rare, significant complications can occur, and they are primarily related to the umbilical insertion site. Vascular injuries can result in hemorrhage that may be life-threatening. Injuries to the bowel can cause a delayed peritonitis. It is very important that these injuries be recognized as early as possible.[12]\n\nSome patients have sustained electrical burns unseen by surgeons who are working with electrodes that leak current into surrounding tissue. The resulting injuries can result in perforated organs and can also lead to peritonitis.This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2018) (Learn how and when to remove this template message)\nThere may be an increased risk of hypothermia and peritoneal trauma due to increased exposure to cold, dry gases during insufflation. The use of surgical humidification therapy, which is the use of heated and humidified CO2 for insufflation, has been shown to reduce this risk.[13]\nMany patients with existing pulmonary disorders may not tolerate pneumoperitoneum (gas in the abdominal cavity), resulting in a need for conversion to open surgery after the initial attempt at laparoscopic approach.\nNot all of the CO\r\n2 introduced into the abdominal cavity is removed through the incisions during surgery. Gas tends to rise, and when a pocket of CO2 rises in the abdomen, it pushes against the diaphragm (the muscle that separates the abdominal from the thoracic cavities and facilitates breathing), and can exert pressure on the phrenic nerve. This produces a sensation of pain that may extend to the patient's shoulders. For an appendectomy, the right shoulder can be particularly painful. In some cases this can also cause considerable pain when breathing. In all cases, however, the pain is transient, as the body tissues will absorb the CO2 and eliminate it through respiration.[14]\nCoagulation disorders and dense adhesions (scar tissue) from previous abdominal surgery may pose added risk for laparoscopic surgery and are considered relative contra-indications for this approach.\nIntra-abdominal adhesion formation is a risk associated with both laparoscopic and open surgery and remains a significant, unresolved problem.[15] Adhesions are fibrous deposits that connect tissue to organ post surgery. Generally, they occur in 50-100% of all abdominal surgeries,[15] with the risk of developing adhesions being the same for both procedures.[16][17] Complications of adhesions include chronic pelvic pain, bowel obstruction, and female infertility. In particular, small bowel obstruction poses the most significant problem.[16] The use of surgical humidification therapy during laparoscopic surgery may minimise the incidence of adhesion formation.[18] Other techniques to reduce adhesion formation include the use of physical barriers such as films or gels, or broad-coverage fluid agents to separate tissues during healing following surgery.[16]\nRobotic laparoscopic surgery \nMain article: Robotic surgery\n A laparoscopic robotic surgery machine.\nIn recent years, electronic tools have been developed to aid surgeons. Some of the features include:\n\nVisual magnification \u2014 use of a large viewing screen improves visibility\nStabilization \u2014 Electromechanical damping of vibrations, due to machinery or shaky human hands\nSimulators \u2014 use of specialized virtual reality training tools to improve physicians' proficiency in surgery [19]\nReduced number of incisions\nThere has been a distinct lack of disclosure regarding nano-scale developments in keyhole surgery and remote medicine, a \"disparity of disclosure\" which does not correlate with the rapid advancements in both the medical and nanotechnology fields over the last two decades.[citation needed ]\nRobotic surgery has been touted as a solution to underdeveloped nations, whereby a single central hospital can operate several remote machines at distant locations. The potential for robotic surgery has had strong military interest as well, with the intention of providing mobile medical care while keeping trained doctors safe from battle.[citation needed ]\n\nNon-robotic hand guided assistance systems \nThere are also user-friendly non robotic assistance systems that are single hand guided devices with a high potential to save time and money. These assistance devices are not bound by the restrictions of common medical robotic systems. The systems enhance the manual possibilities of the surgeon and his\/her team, regarding the need of replacing static holding force during the intervention.[citation needed ]\nSome of the features are:[citation needed ]\n\nThe stabilisation of the camera picture because the whole static workload is conveyed by the assistance system.\nSome systems enable a fast repositioning and very short time for fixation of less than 0.02 seconds at the desired position. Some systems are lightweight constructions (18 kg) and can withstand a force of 20 N in any position and direction.\nThe benefit \u2013 a physically relaxed intervention team can work concentrated on the main goals during the intervention.\nThe potentials of these systems enhance the possibilities of the mobile medical care with those lightweight assistance systems. These assistance systems meet the demands of true solo surgery assistance systems and are robust, versatile, and easy to use.\nHistory \n Hans Christian Jacobaeus\nIt is difficult to credit one individual with the pioneering of the laparoscopic approach. In 1901, Georg Kelling of Dresden, Germany, performed the first laparoscopic procedure in dogs, and, in 1910, Hans Christian Jacobaeus of Sweden performed the first laparoscopic operation in humans.[20]\nIn the ensuing several decades, numerous individuals refined and popularized the approach further for laparoscopy. The advent of computer chip-based television cameras was a seminal event in the field of laparoscopy. This technological innovation provided the means to project a magnified view of the operative field onto a monitor and, at the same time, freed both the operating surgeon's hands, thereby facilitating performance of complex laparoscopic procedures. Prior to its conception, laparoscopy was a surgical approach with very few applications, mainly for purposes of diagnosis and performance of simple procedures in gynecologic applications.[citation needed ]\nThe first publication on modern diagnostic laparoscopy by Raoul Palmer appeared in 1947,[21] followed by the publication of Hans Frangenheim and Kurt Semm. Hans Lindermann and Kurt Semm practised CO\r\n2 hysteroscopy during the mid-1970s.[citation needed ]\nIn 1972, Clarke invented, published, patented, presented, and recorded on film laparoscopic surgery, with instruments marketed by the Ven Instrument Company of Buffalo, New York.[22]\nIn 1975, Tarasconi, from the Department of Ob-Gyn of the University of Passo Fundo Medical School (Passo Fundo, RS, Brazil), started his experience with organ resection by laparoscopy (Salpingectomy), first reported in the Third AAGL Meeting, Hyatt Regency Atlanta, November 1976 and later published in The Journal of Reproductive Medicine in 1981.[23]\nThis laparoscopic surgical procedure was the first laparoscopic organ resection reported in medical literature.\n\n<\/p>In 1981, Semm, from the gynecological clinic of Kiel University, Germany, performed the first laparoscopic appendectomy. Following his lecture on laparoscopic appendectomy, the president of the German Surgical Society wrote to the Board of Directors of the German Gynecological Society suggesting suspension of Semm from medical practice. Subsequently, Semm submitted a paper on laparoscopic appendectomy to the American Journal of Obstetrics and Gynecology, at first rejected as unacceptable for publication on the grounds that the technique reported on was \"unethical,\" but finally published in the journal Endoscopy.[24]\nThe abstract of his paper on endoscopic appendectomy can be found at here.\nSemm established several standard procedures that were regularly performed, such as ovarian cyst enucleation, myomectomy, treatment of ectopic pregnancy and finally laparoscopic-assisted vaginal hysterectomy (nowadays termed as cervical intra-fascial Semm hysterectomy). He also developed a medical instrument company Wisap in Munich, Germany, which still produces various endoscopic instruments of high quality. In 1985, he constructed the pelvi-trainer = laparo-trainer, a practical surgical model whereby colleagues could practice laparoscopic techniques. Semm published over 1000 papers in various journals.[4] He also produced over 30 endoscopic films and more than 20,000 colored slides to teach and inform interested colleagues about his technique. His first atlas, More Details on Pelviscopy and Hysteroscopy was published in 1976, a slide atlas on pelviscopy, hysteroscopy, and fetoscopy in 1979, and his books on gynecological endoscopic surgery in German, English, and many other languages in 1984, 1987, and 2002.\n\n<\/p>Prior to 1990, the only specialty performing laparoscopy on a widespread basis was gynecology, mostly for relatively short, simple procedures such as a diagnostic laparoscopy or tubal ligation. The introduction in 1990 of a laparoscopic clip applier with twenty automatically advancing clips (rather than a single load clip applier that would have to be taken out, reloaded and reintroduced for each clip application) made general surgeons more comfortable with making the leap to laparoscopic cholecystectomies (gall bladder removal). On the other hand, some surgeons continue to use the single clip appliers as they save as much as $200 per case for the patient, detract nothing from the quality of the clip ligation, and add only seconds to case lengths. It must be noted that both laparoscopy tubal ligations and cholecystectomies may be performed using suturing and tying, thus further reducing the expensive cost of single and multiclips (when compared to suture). Once again this may increase case lengths but costs are greatly reduced (ideal for developing countries) and widespread accidents of loose clips are eliminated.[citation needed ]\n\nGynecological diagnosis \nFurther information: Fertiloscope\nIn gynecology, diagnostic laparoscopy may be used to inspect the outside of the uterus, ovaries, and fallopian tubes, as, for example, in the diagnosis of female infertility. Usually, one incision is placed near the navel and a second near the pubic hairline. A special type of laparoscope called a fertiloscope, which is modified for transvaginal application, can be used. A dye test may be performed to detect any blockage in the reproductive tract, wherein a dark blue dye is passed up through the cervix and is followed with the laparoscope through its passage out into the fallopian tubes to the ovaries.[1]\n\nSee also \nArthroscopic surgery\nLaparotomy, an older open surgery technique for operations on the abdomen\nPercutaneous (surgery)\nInvasiveness of surgical procedures\nNatural orifice translumenal endoscopic surgery (NOTES)\nRevision weight loss surgery\nSingle port laparoscopy\nReferences \n\n\n^ a b MedlinePlus > Laparoscopy Archived 2011-07-26 at the Wayback Machine. Update Date: 8\/21\/2009. Updated by: James Lee, MD \/\/ No longer valid \n\n^ Mastery of Endoscopic and Laparoscopic Surgery W. Stephen, M.D. Eubanks; Steve Eubanks (Editor); Lee L., M.D. Swanstrom (Editor); Nathaniel J. Soper (Editor) Lippincott Williams & Wilkins 2nd Edition 2004 \n\n^ \"Training in diagnostic laparoscopy\". Gfmer.ch. Archived from the original on July 14, 2014. Retrieved October 10, 2013 . \n\n^ Bhandarkar, Deepraj; Mittal, Gaurav; Shah, Rasik; Katara, Avinash; Udwadia, Tehemton E (January 1, 2011). \"Single-incision laparoscopic cholecystectomy: How I do it?\". Journal of Minimal Access Surgery. 7 (1): 17\u201323. doi:10.4103\/0972-9941.72367. ISSN 0972-9941. PMC 3002000 . PMID 21197237. \n\n^ Jimenez-Rodr\u00edguez, RM; Segura-Sampedro, JJ (February 2016). \"Laparoscopic approach in gastrointestinal emergencies\". World Journal of Gastroenterology. 22 (9): 2701. doi:10.3748\/wjg.v22.i9.2701. \n\n^ Raveenthiran, V (October\u2013December 2010). \"Pediatric laparoscopy: Facts and factitious claims\". J Indian Assoc Pediatr Surg. 15 (4): 122\u2013126. doi:10.4103\/0971-9261.72434. PMC 2995935 . PMID 21170193. Archived from the original on 2017-09-03. \n\n^ Westebring-van der Putten EP; Goossens RHM; Jakimowicz JJ; Dankelman J (2008). \"Haptics in Minimally Invasive Surgery \u2013 A Review\". Minimally Invasive Therapy. 17 (1): 3\u201316. doi:10.1080\/13645700701820242. \n\n^ A. G. Gallagher; N. McClure; J. McGuigan; K. Ritchie; N. P. Sheehy (2007). \"An Ergonomic Analysis of the Fulcrum Effect in the Acquisition of Endoscopic Skills\". Endoscopy. 1 (7): 617\u2013620. doi:10.1055\/s-2007-1001366. \n\n^ Rodriguez, Anthony, Carpel Tunnel Surgery in Review, Beklind, 2009p.234 \n\n^ Mayol, Julio; Garcia-Aguilar, Julio; Ortiz-Oshiro, Elena; De-Diego Carmona, Jose A.; Fernandez-Represa, Jesus A. (1997). \"Risks of the Minimal Access Approach for Laparoscopic Surgery: Multivariate Analysis of Morbidity Related to Umbilical Trocar Insertion\". World Journal of Surgery. 21 (5): 529\u2013533. doi:10.1007\/PL00012281. ISSN 0364-2313. \n\n^ Mirhashemi R, Harlow BL, Ginsburg ES, Signorello LB, Berkowitz R, Feldman S (September 1998). \"Predicting risk of complications with gynecologic laparoscopic surgery\". Obstet Gynecol. 92 (3): 327\u201331. doi:10.1016\/S0029-7844(98)00209-9. PMID 9721764. \n\n^ Janie Fuller, DDS, (CAPT, USPHS), Walter Scott, Ph.D. (CAPT, USPHS), Binita Ashar, M.D., Julia Corrado, M.D. FDA, CDRH, \"Laparoscopic Trocar Injuries: A report from a U.S. Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH) Systematic Technology Assessment of Medical Products (STAMP) Committee\" Archived 2007-08-23 at the Wayback Machine.\n Finalized: November 7, 2003 \n\n^ Peng Y, Zheng M, Ye Q, Chen X, Yu B, Liu B (January 2009). \"Heated and humidified CO\r\n2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations\". J. Surg. Res. 151 (1): 40\u20137. doi:10.1016\/j.jss.2008.03.039. PMID 18639246. Archived from the original on 2018-04-27. \n\n^ Alexander JI, Hull MG (March 1987). \"Abdominal pain after laparoscopy: the value of a gas drain\". Br J Obstet Gynaecol. 94 (3): 267\u20139. doi:10.1111\/j.1471-0528.1987.tb02366.x. PMID 2952161. \n\n^ a b D\u00f6rthe, Br\u00fcggmann; Garri Tchartchian; Markus Wallwiener; Karsten M\u00fcnstedt; Hans-Rudolf Tinneberg; Andreas Hackethal (November 2010). \"Intra-abdominal Adhesions \u2013 Definition, Origin, Significance in Surgical Practice, and Treatment Options\". Dtsch Arztebl Int. 107 (44): 769\u2013775. doi:10.3238\/arztebl.2010.0769. PMC 2992017 . PMID 21116396. \n\n^ a b c DeWilde, Rudy Leon; Geoffrey Trew (September 2007). \"Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position\". Gynecological Surgery. 4 (3): 161\u2013168. doi:10.1007\/s10397-007-0338-x. Archived from the original on 2013-07-11. \n\n^ Lower, A.M.; R.J.S. Hawthorn; D. Clark; J.H. Boyd; A.R. Finlayson; A.D. Knight; A.M. Crowe (2004). \"Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24\u2009046 patients\". Human Reproduction. 19 (8): 1877\u20131885. doi:10.1093\/humrep\/deh321. PMID 15178659. Archived from the original on 2016-02-08. \n\n^ Peng, Y; Zheng M; Ye Q; Chen X; Yu B; Liu B (Jan 2009). \"Heated and Humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations\". J Surg Res. 151 (1): 40\u20137. doi:10.1016\/j.jss.2008.03.039. PMID 18639246. \n\n^ Ahmed K, Keeling AN, Fakhry M, et al. (January 2010). \"Role of virtual reality simulation in teaching and assessing technical skills in endovascular intervention\". J Vasc Interv Radiol. 21 (1): 55\u201366. doi:10.1016\/j.jvir.2009.09.019. PMID 20123191. Archived from the original on 2017-12-22. \n\n^ Journal of Endourology Hans Christian Jacobaeus: Inventor of Human Laparoscopy and Thoracoscopy \n\n^ Palmer, R (1947). \"Instrumentation et technique de la coelioscopie gynecologique\". Gynecol Obstet (Paris). 46 (4): 420\u201331. PMID 18917806. \n\n^ Clarke HC (April 1972). \"Laparoscopy\u2014new instruments for suturing and ligation\". Fertil. Steril. 23 (4): 274\u20137. doi:10.1016\/S0015-0282(16)38886-0. PMID 4258561. \n\n^ Tarasconi JC (October 1981). \"Endoscopic salpingectomy\". J Reprod Med. 26 (10): 541\u20135. PMID 6458700. \n\n^ Semm K (March 1983). \"Endoscopic Appendectomy\". Endoscopy. 15 (2): 59\u201364. doi:10.1055\/s-2007-1021466. PMID 6221925. \n\n\nExternal links \nFeder, Barnaby J., \"Surgical Device Poses a Rare but Serious Peril\" The New York Times, March 17, 2006\nvteEndoscopyGastrointestinal tract\nUpper:\nEsophagogastroduodenoscopy\nLower: Enteroscopy\nColonoscopy\nSigmoidoscopy\nProctoscopy\nAnoscopy\nCapsule endoscopy\nAccessory: Endoscopic retrograde cholangiopancreatography\nRespiratory tract\nRhinoscopy\nLaryngoscopy\nBronchoscopy\nUrinary tract\nNephroscopy\nUreteroscopy\nCystoscopy\nFemale reproductive system\nColposcopy\nHysteroscopy\nFalloposcopy\nCuldoscopy\nClosed cavity via incision\nLaparoscopy\nLaparoscopic surgery\nArthroscopy\nThoracoscopy\nMediastinoscopy\nCoelioscopy\nOther\nFetoscopy\nAngioscopy\nOtoscopy\n\nvteSurgical procedures involving the digestive system (ICD-9-CM V3 42\u201354, ICD-10-PCS 0D)Digestive tractUpper GI tractSGs \/ Esophagus\nEsophagectomy\nHeller myotomy\nSialography\nImpedance\u2013pH monitoring\nEsophageal pH monitoring\nEsophageal motility study\nStomach\nBariatric surgery\nAdjustable gastric band\nEndoscopic sleeve gastroplasty\nGastric bypass surgery\nSleeve gastrectomy\nVertical banded gastroplasty surgery\nCollis gastroplasty\nGastrectomy\nBillroth I\nBillroth II\nRoux-en-Y\nGastroenterostomy\nGastropexy\nGastrostomy\nPercutaneous endoscopic gastrostomy\nEsophagogastric dissociation\nHill repair\nNissen fundoplication\nPyloromyotomy\nMedical imaging\nEndoscopy: Esophagogastroduodenoscopy\nBarium swallow\nUpper gastrointestinal series\nLower GI tractSmall bowel\nBariatric surgery\nDuodenal switch\nJejunoileal bypass\nBowel resection\nIleostomy\nIntestine transplantation\nJejunostomy\nPartial ileal bypass surgery\nStrictureplasty\nLarge bowel\nAppendicectomy\nColectomy\nColonic polypectomy\nColostomy\nHartmann's operation\nRectum\nAbdominoperineal resection \/ Miles operation\nLower anterior resection\nTotal mesorectal excision\nAnal canal\nAnal sphincterotomy\nAnorectal manometry\nLateral internal sphincterotomy\nRubber band ligation\nTransanal hemorrhoidal dearterialization\nMedical imaging\nEndoscopy: Colonoscopy\nAnoscopy\nCapsule endoscopy\nEnteroscopy\nProctoscopy\nSigmoidoscopy\nAbdominal ultrasonography\nDefecography\nDouble-contrast barium enema\nEndoanal ultrasound\nEnteroclysis\nLower gastrointestinal series\nSmall-bowel follow-through\nTransrectal ultrasonography\nVirtual colonoscopy\nStool tests\nFecal fat test\nFecal pH test\nStool guaiac test\nAccessoryLiver\nArtificial extracorporeal liver support\nBioartificial liver devices\nLiver dialysis\nHepatectomy\nLiver biopsy\nLiver transplantation\nPortal hypertension\nTransjugular intrahepatic portosystemic shunt [TIPS]\nDistal splenorenal shunt procedure\nGallbladder, bile duct\nCholecystectomy\nCholecystostomy\nERCP\nHepatoportoenterostomy\nMedical imaging: Cholangiography\nIV\nMRCP\nPTC\nCholecystography\nCholescintigraphy\nPancreas\nFrey's procedure\nPancreas transplantation\nPancreatectomy\nPancreaticoduodenectomy\nPuestow procedure\nAbdominopelvicPeritoneum\nDiagnostic peritoneal lavage\nIntraperitoneal injection\nLaparoscopy\nOmentopexy\nParacentesis\nPeritoneal dialysis\nHernia\nHernia repair: Inguinal hernia surgery\nFemoral hernia repair\nOther\nLaparotomy\nExploratory laparotomy\nRapid urease test \/ Urea breath test\nCPRs\nMELD\nPELD\nUKELD\nChild\u2013Pugh score\nRanson criteria\nMilan criteria\n\nAuthority control \nNDL: 00563624 \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Laparoscopic_surgery\">https:\/\/www.limswiki.org\/index.php\/Laparoscopic_surgery<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","bc5b7003f9b6b64085881e0e1ffa3d21_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Laparoscopic_surgery skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Laparoscopic surgery<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Laparoscopy<\/b> (from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Greek_language\" class=\"mw-redirect\" title=\"Ancient Greek language\" rel=\"external_link\" target=\"_blank\">Ancient Greek<\/a> <i> <\/i>\u03bb\u03b1\u03c0\u03ac\u03c1\u03b1<i> (lapara)<\/i>, meaning 'flank, side', and <i> <\/i>\u03c3\u03ba\u03bf\u03c0\u03ad\u03c9<i> (skopeo)<\/i>, meaning 'to see') is an operation performed in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdomen\" title=\"Abdomen\" rel=\"external_link\" target=\"_blank\">abdomen<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_pelvis\" class=\"mw-redirect\" title=\"Human pelvis\" rel=\"external_link\" target=\"_blank\">pelvis<\/a> using small <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_incision\" title=\"Surgical incision\" rel=\"external_link\" target=\"_blank\">incisions<\/a> (usually 0.5\u20131.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.<sup id=\"rdp-ebb-cite_ref-medlineplus_1-0\" class=\"reference\"><a href=\"#cite_note-medlineplus-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Laparoscopic surgery, also called <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive\" class=\"mw-redirect\" title=\"Minimally invasive\" rel=\"external_link\" target=\"_blank\">minimally invasive<\/a> surgery<\/i> (MIS), <i>bandaid surgery<\/i>, or <i>keyhole surgery<\/i>, is a modern <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgical<\/a> technique. There are a number of advantages to the patient with laparoscopic surgery versus the more common, open procedure. These include reduced pain due to smaller incisions, reduced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemorrhaging\" class=\"mw-redirect\" title=\"Hemorrhaging\" rel=\"external_link\" target=\"_blank\">hemorrhaging<\/a> and shorter recovery time. The key element is the use of a <b>laparoscope<\/b>, a long fiber optic cable system which allows viewing of the affected area by snaking the cable from a more distant, but more easily accessible location.\n<\/p><p>Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Specific surgical instruments used in a laparoscopic surgery include forceps, scissors, probes, dissectors, hooks and retractors. Laparoscopic and thoracoscopic surgery belong to the broader field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopy\" title=\"Endoscopy\" rel=\"external_link\" target=\"_blank\">endoscopy<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gallbladderop.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Gallbladderop.jpg\/220px-Gallbladderop.jpg\" width=\"220\" height=\"204\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gallbladderop.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholecystectomy\" title=\"Cholecystectomy\" rel=\"external_link\" target=\"_blank\">Cholecystectomy<\/a> as seen through a laparoscope<\/div><\/div><\/div>\n<p>There are two types of laparoscope:<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<ol><li>a telescopic rod <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lens_(optics)\" title=\"Lens (optics)\" rel=\"external_link\" target=\"_blank\">lens<\/a> system, usually connected to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Video_camera\" title=\"Video camera\" rel=\"external_link\" target=\"_blank\">video camera<\/a> (single <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charge-coupled_device\" title=\"Charge-coupled device\" rel=\"external_link\" target=\"_blank\">chip<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Three-CCD\" class=\"mw-redirect\" title=\"Three-CCD\" rel=\"external_link\" target=\"_blank\">three chip<\/a>)<\/li>\n<li>a digital laparoscope where a miniature digital video camera is placed at the end of the laparoscope, eliminating the rod lens system<\/li><\/ol>\n<p>The mechanism mentioned in the second type is mainly used to improve the image quality of flexible endoscopes, replacing traditional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiberscope\" title=\"Fiberscope\" rel=\"external_link\" target=\"_blank\">fiberscopes<\/a>. Nevertheless, laparoscopes are rigid endoscopes. The rigidity is required in clinical practice. The rod-lens based laparoscopes dominate overwhelmingly in practice, due to their fine optical resolution (50 \u00b5m typically, dependant on the aperture size used in the objective lens), and the image quality can be better than that of the digital camera if necessary. The second type of laparoscope is very rare in the laparoscope market and in hospitals.\n<\/p><p>Also attached is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiber_optic\" class=\"mw-redirect\" title=\"Fiber optic\" rel=\"external_link\" target=\"_blank\">fiber optic<\/a> cable system connected to a \"cold\" light source (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Halogen_lamp\" title=\"Halogen lamp\" rel=\"external_link\" target=\"_blank\">halogen<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Xenon_arc_lamp\" title=\"Xenon arc lamp\" rel=\"external_link\" target=\"_blank\">xenon<\/a>), to illuminate the operative field, which is inserted through a 5 mm or 10 mm <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cannula\" title=\"Cannula\" rel=\"external_link\" target=\"_blank\">cannula<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trocar\" title=\"Trocar\" rel=\"external_link\" target=\"_blank\">trocar<\/a>. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdomen\" title=\"Abdomen\" rel=\"external_link\" target=\"_blank\">abdomen<\/a> is usually <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insufflation_(medicine)\" title=\"Insufflation (medicine)\" rel=\"external_link\" target=\"_blank\">insufflated<\/a> with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_dioxide\" title=\"Carbon dioxide\" rel=\"external_link\" target=\"_blank\">carbon dioxide<\/a> gas. This elevates the abdominal wall above the internal organs to create a working and viewing space. CO<sub>2<\/sub> is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Procedures\">Procedures<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laparoscopic_stomach_surgery.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c3\/Laparoscopic_stomach_surgery.jpg\/220px-Laparoscopic_stomach_surgery.jpg\" width=\"220\" height=\"161\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laparoscopic_stomach_surgery.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Surgeons perform laparoscopic stomach surgery.<\/div><\/div><\/div>\n<p>Laparoscopic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholecystectomy\" title=\"Cholecystectomy\" rel=\"external_link\" target=\"_blank\">cholecystectomy<\/a> is the most common laparoscopic procedure performed. In this procedure, 5\u201310 mm diameter instruments (graspers, scissors, clip applier) can be introduced by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgeon<\/a> into the abdomen through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trocar\" title=\"Trocar\" rel=\"external_link\" target=\"_blank\">trocars<\/a> (hollow tubes with a seal to keep the <span class=\"chemf nowrap\">CO<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">2<\/sub><\/span><\/span> from leaking). Over one million cholecystectomies are performed in the U.S. annually, with over 96% of those being performed laparoscopically.\n<\/p><p>Rather than a minimum 20 cm incision as in traditional (open) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholecystectomy\" title=\"Cholecystectomy\" rel=\"external_link\" target=\"_blank\">cholecystectomy<\/a>, four incisions of 0.5\u20131.0 cm, or more recently a single incision of 1.5\u20132.0 cm,<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> will be sufficient to perform a laparoscopic removal of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gallbladder\" title=\"Gallbladder\" rel=\"external_link\" target=\"_blank\">gallbladder<\/a>. Since the gallbladder is similar to a small balloon that stores and releases bile, it can usually be removed from the abdomen by suctioning out the bile and then removing the deflated gallbladder through the 1 cm incision at the patient's navel. The length of postoperative stay in the hospital is minimal, and same-day discharges are possible in cases of early morning procedures.\n<\/p><p>In certain advanced laparoscopic procedures, where the size of the specimen being removed would be too large to pull out through a trocar site (as would be done with a gallbladder), an incision larger than 10 mm must be made. The most common of these procedures are removal of all or part of the colon (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Colectomy\" title=\"Colectomy\" rel=\"external_link\" target=\"_blank\">colectomy<\/a>), or removal of the kidney (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Nephrectomy\" title=\"Nephrectomy\" rel=\"external_link\" target=\"_blank\">nephrectomy<\/a>). Some surgeons perform these procedures completely laparoscopically, making the larger incision toward the end of the procedure for specimen removal, or, in the case of a colectomy, to also prepare the remaining healthy bowel to be reconnected (create an anastomosis). Many other surgeons feel that since they will have to make a larger incision for specimen removal anyway, they might as well use this incision to have their hand in the operative field during the procedure to aid as a retractor, dissector, and to be able to feel differing tissue densities (palpate), as they would in open surgery. This technique is called hand-assist laparoscopy. Since they will still be working with scopes and other laparoscopic instruments, CO<sub>2<\/sub> will have to be maintained in the patient's abdomen, so a device known as a hand access port (a sleeve with a seal that allows passage of the hand) must be used. Surgeons who choose this hand-assist technique feel it reduces operative time significantly versus the straight laparoscopic approach. It also gives them more options in dealing with unexpected adverse events (e.g., uncontrolled bleeding) that may otherwise require creating a much larger incision and converting to a fully open surgical procedure.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Conceptually, the laparoscopic approach is intended to minimise post-operative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\" title=\"Pain\" rel=\"external_link\" target=\"_blank\">pain<\/a> and speed up recovery times, while maintaining an enhanced visual field for surgeons. Due to improved patient outcomes, in the last two decades, laparoscopic surgery has been adopted by various surgical sub-specialties, including gastrointestinal surgery (including bariatric procedures for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Obesity\" title=\"Obesity\" rel=\"external_link\" target=\"_blank\">morbid obesity<\/a>), gynecologic surgery, and urology. Based on numerous prospective <a href=\"https:\/\/en.wikipedia.org\/wiki\/Randomized_controlled_trial\" title=\"Randomized controlled trial\" rel=\"external_link\" target=\"_blank\">randomized controlled trials<\/a>, the approach has proven to be beneficial in reducing post-operative morbidities such as wound infections and incisional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hernia\" title=\"Hernia\" rel=\"external_link\" target=\"_blank\">hernias<\/a> (especially in morbidly obese patients), and is now deemed safe when applied to surgery for cancers such as cancer of colon.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laparoscopic_Hand_Instruments_001_JPN.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b4\/Laparoscopic_Hand_Instruments_001_JPN.jpg\/220px-Laparoscopic_Hand_Instruments_001_JPN.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laparoscopic_Hand_Instruments_001_JPN.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Laparoscopic instruments.<\/div><\/div><\/div>\n<p>The restricted vision, the difficulty in handling of the instruments (new hand-eye coordination skills are needed), the lack of tactile perception, and the limited working area are factors adding to the technical complexity of this surgical approach. For these reasons, minimally invasive surgery has emerged as a highly competitive new sub-specialty within various fields of surgery. Surgical residents who wish to focus on this area of surgery gain additional laparoscopic surgery training during one or two years of fellowship after completing their basic surgical residency. In OB-GYN residency programs, the average laparoscopy-to-laparotomy quotient (LPQ) is 0.55.\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lindbergh_operation\" title=\"Lindbergh operation\" rel=\"external_link\" target=\"_blank\">first transatlantic surgery (Lindbergh operation)<\/a> ever performed was a laparoscopic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gallbladder\" title=\"Gallbladder\" rel=\"external_link\" target=\"_blank\">gallbladder<\/a> removal.\n<\/p><p>Laparoscopic techniques have also been developed in the field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Veterinary_medicine\" title=\"Veterinary medicine\" rel=\"external_link\" target=\"_blank\">veterinary medicine<\/a>. Due to the relative high cost of the equipment required, however, it has not become commonplace in most traditional practices today but rather limited to specialty-type practices. Many of the same surgeries performed in humans can be applied to animal cases \u2013 everything from an egg-bound tortoise to a German Shepherd can benefit from MIS. A paper published in JAVMA (Journal of the American Veterinary Medical Association) in 2005 showed that dogs spayed laparoscopically experienced significantly less pain (65%) than those that were spayed with traditional \"open\" methods. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroscopy\" title=\"Arthroscopy\" rel=\"external_link\" target=\"_blank\">Arthroscopy<\/a>, thoracoscopy, cystoscopy are all performed in veterinary medicine today. The University of Georgia School of Veterinary Medicine and Colorado State University's School of Veterinary Medicine are two of the main centers where veterinary laparoscopy got started and have excellent training programs for veterinarians interested in getting started in MIS.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Advantages\">Advantages<\/span><\/h3><p>\nThere are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include:<\/p>\n<ul><li>Reduced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemorrhaging\" class=\"mw-redirect\" title=\"Hemorrhaging\" rel=\"external_link\" target=\"_blank\">hemorrhaging<\/a>, which reduces the chance of needing a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_transfusion\" title=\"Blood transfusion\" rel=\"external_link\" target=\"_blank\">blood transfusion<\/a>.<\/li>\n<li>Smaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.<\/li>\n<li>Less pain, leading to less <a href=\"https:\/\/en.wikipedia.org\/wiki\/Analgesic\" title=\"Analgesic\" rel=\"external_link\" target=\"_blank\">pain medication<\/a> needed.<\/li>\n<li>Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.<\/li>\n<li>Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.<\/li>\n<li>There are more indications for laparoscopic surgery in gastrointestinal emergencies as the field develops.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><\/li><\/ul>\n<p>Although laparoscopy in adult age group is widely accepted, its advantages in pediatric age group is questioned. Benefits of laparoscopy appears to recede with younger age. Efficacy of laparoscopy is inferior to open surgery in certain conditions such as pyloromyotomy for Infantile hypertrophic pyloric stenosis. Although laparoscopic appendectomy has lesser wound problems than open surgery, the former is associated with more intra-abdominal abscesses.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Disadvantages\">Disadvantages<\/span><\/h3>\n<p>While laparoscopic surgery is clearly advantageous in terms of patient outcomes, the procedure is more difficult from the surgeon's perspective when compared to traditional, open surgery:\n<\/p>\n<ul><li>The surgeon has a limited range of motion at the surgical site, resulting in a loss of dexterity.<\/li>\n<li>Poor depth perception.<\/li>\n<li>Surgeons must use tools to interact with tissue rather than manipulate it directly with their hands. This results in an inability to accurately judge how much force is being applied to tissue as well as a risk of damaging tissue by applying more force than necessary. This limitation also reduces tactile sensation, making it more difficult for the surgeon to feel tissue (sometimes an important diagnostic tool, such as when palpating for tumors) and making delicate operations such as tying sutures more difficult.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><\/li>\n<li>The tool endpoints move in the opposite direction to the surgeon's hands due to the pivot point, making laparoscopic surgery a non-intuitive motor skill that is difficult to learn. This is called the <i>fulcrum effect<\/i>.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><\/li>\n<li>Some surgeries (carpal tunnel for instance) generally turn out better for the patient when the area can be opened up, allowing the surgeon to see \"the whole picture\" surrounding physiology, to better address the issue at hand. In this regard, keyhole surgery can be a disadvantage.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h3>\n<p>Some of the risks are briefly described below:\n<\/p>\n<ul><li>The most significant risks are from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trocar\" title=\"Trocar\" rel=\"external_link\" target=\"_blank\">trocar<\/a> injuries during insertion into the abdominal cavity, as the trocar is typically inserted blindly. Injuries include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominal_wall\" title=\"Abdominal wall\" rel=\"external_link\" target=\"_blank\">abdominal wall<\/a> hematoma, umbilical hernias, umbilical wound infection, and penetration of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_vessel\" title=\"Blood vessel\" rel=\"external_link\" target=\"_blank\">blood vessels<\/a> or small or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colon_(anatomy)\" class=\"mw-redirect\" title=\"Colon (anatomy)\" rel=\"external_link\" target=\"_blank\">large bowel<\/a>.<sup id=\"rdp-ebb-cite_ref-MayolGarcia-Aguilar1997_10-0\" class=\"reference\"><a href=\"#cite_note-MayolGarcia-Aguilar1997-10\" rel=\"external_link\">[10]<\/a><\/sup><\/li><\/ul>\n<p>The risk of such injuries is increased in patients who have a low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Body_mass_index\" title=\"Body mass index\" rel=\"external_link\" target=\"_blank\">body mass index<\/a><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> or have a history of prior <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominal_surgery\" title=\"Abdominal surgery\" rel=\"external_link\" target=\"_blank\">abdominal surgery<\/a>. While these injuries are rare, significant complications can occur, and they are primarily related to the umbilical insertion site. Vascular injuries can result in hemorrhage that may be life-threatening. Injuries to the bowel can cause a delayed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritonitis\" title=\"Peritonitis\" rel=\"external_link\" target=\"_blank\">peritonitis<\/a>. It is very important that these injuries be recognized as early as possible.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<ul><li>Some patients have sustained electrical burns unseen by surgeons who are working with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrode\" title=\"Electrode\" rel=\"external_link\" target=\"_blank\">electrodes<\/a> that leak current into surrounding tissue. The resulting injuries can result in perforated organs and can also lead to peritonitis.<\/li>\n<li>There may be an increased risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypothermia\" title=\"Hypothermia\" rel=\"external_link\" target=\"_blank\">hypothermia<\/a> and peritoneal trauma due to increased exposure to cold, dry gases during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insufflation_(medicine)\" title=\"Insufflation (medicine)\" rel=\"external_link\" target=\"_blank\">insufflation<\/a>. The use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_humidification\" title=\"Surgical humidification\" rel=\"external_link\" target=\"_blank\">surgical humidification<\/a> therapy, which is the use of heated and humidified CO<sub>2<\/sub> for insufflation, has been shown to reduce this risk.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><\/li>\n<li>Many patients with existing pulmonary disorders may not tolerate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pneumoperitoneum\" title=\"Pneumoperitoneum\" rel=\"external_link\" target=\"_blank\">pneumoperitoneum<\/a> (gas in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominal_cavity\" title=\"Abdominal cavity\" rel=\"external_link\" target=\"_blank\">abdominal cavity<\/a>), resulting in a need for conversion to open surgery after the initial attempt at laparoscopic approach.<\/li>\n<li>Not all of the <span class=\"chemf nowrap\">CO<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">2<\/sub><\/span><\/span> introduced into the abdominal cavity is removed through the incisions during surgery. Gas tends to rise, and when a pocket of CO<sub>2<\/sub> rises in the abdomen, it pushes against the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thoracic_diaphragm\" title=\"Thoracic diaphragm\" rel=\"external_link\" target=\"_blank\">diaphragm<\/a> (the muscle that separates the abdominal from the thoracic cavities and facilitates breathing), and can exert pressure on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phrenic_nerve\" title=\"Phrenic nerve\" rel=\"external_link\" target=\"_blank\">phrenic nerve<\/a>. This produces a sensation of pain that may extend to the patient's shoulders. For an appendectomy, the right shoulder can be particularly painful. In some cases this can also cause considerable pain when breathing. In all cases, however, the pain is transient, as the body tissues will absorb the CO<sub>2<\/sub> and eliminate it through respiration.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulation\" title=\"Coagulation\" rel=\"external_link\" target=\"_blank\">Coagulation<\/a> disorders and dense <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adhesions\" class=\"mw-redirect\" title=\"Adhesions\" rel=\"external_link\" target=\"_blank\">adhesions<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Scar\" title=\"Scar\" rel=\"external_link\" target=\"_blank\">scar tissue<\/a>) from previous abdominal surgery may pose added risk for laparoscopic surgery and are considered relative contra-indications for this approach.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Intra-abdominal_adhesion\" class=\"mw-redirect\" title=\"Intra-abdominal adhesion\" rel=\"external_link\" target=\"_blank\">Intra-abdominal adhesion<\/a> formation is a risk associated with both laparoscopic and open surgery and remains a significant, unresolved problem.<sup id=\"rdp-ebb-cite_ref-d\u00f6rthe769_15-0\" class=\"reference\"><a href=\"#cite_note-d\u00f6rthe769-15\" rel=\"external_link\">[15]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adhesion_(medicine)\" title=\"Adhesion (medicine)\" rel=\"external_link\" target=\"_blank\">Adhesions<\/a> are fibrous deposits that connect tissue to organ post surgery. Generally, they occur in 50-100% of all abdominal surgeries,<sup id=\"rdp-ebb-cite_ref-d\u00f6rthe769_15-1\" class=\"reference\"><a href=\"#cite_note-d\u00f6rthe769-15\" rel=\"external_link\">[15]<\/a><\/sup> with the risk of developing adhesions being the same for both procedures.<sup id=\"rdp-ebb-cite_ref-dewilde161_16-0\" class=\"reference\"><a href=\"#cite_note-dewilde161-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> Complications of adhesions include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_pelvic_pain\" class=\"mw-redirect\" title=\"Chronic pelvic pain\" rel=\"external_link\" target=\"_blank\">chronic pelvic pain<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bowel_obstruction\" title=\"Bowel obstruction\" rel=\"external_link\" target=\"_blank\">bowel obstruction<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Female_infertility\" title=\"Female infertility\" rel=\"external_link\" target=\"_blank\">female infertility<\/a>. In particular, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Small_bowel_obstruction\" class=\"mw-redirect\" title=\"Small bowel obstruction\" rel=\"external_link\" target=\"_blank\">small bowel obstruction<\/a> poses the most significant problem.<sup id=\"rdp-ebb-cite_ref-dewilde161_16-1\" class=\"reference\"><a href=\"#cite_note-dewilde161-16\" rel=\"external_link\">[16]<\/a><\/sup> The use of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_humidification\" title=\"Surgical humidification\" rel=\"external_link\" target=\"_blank\">surgical humidification<\/a> therapy during laparoscopic surgery may minimise the incidence of adhesion formation.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> Other techniques to reduce adhesion formation include the use of physical barriers such as films or gels, or broad-coverage fluid agents to separate tissues during healing following surgery.<sup id=\"rdp-ebb-cite_ref-dewilde161_16-2\" class=\"reference\"><a href=\"#cite_note-dewilde161-16\" rel=\"external_link\">[16]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Robotic_laparoscopic_surgery\">Robotic laparoscopic surgery<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">Robotic surgery<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laproscopic_Surgery_Robot.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Laproscopic_Surgery_Robot.jpg\/220px-Laproscopic_Surgery_Robot.jpg\" width=\"220\" height=\"320\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Laproscopic_Surgery_Robot.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A laparoscopic robotic surgery machine.<\/div><\/div><\/div>\n<p>In recent years, electronic tools have been developed to aid surgeons. Some of the features include:\n<\/p>\n<ul><li>Visual magnification \u2014 use of a large viewing screen improves visibility<\/li>\n<li>Stabilization \u2014 Electromechanical damping of vibrations, due to machinery or shaky human hands<\/li>\n<li>Simulators \u2014 use of specialized <a href=\"https:\/\/en.wikipedia.org\/wiki\/Virtual_reality\" title=\"Virtual reality\" rel=\"external_link\" target=\"_blank\">virtual reality<\/a> training tools to improve physicians' proficiency in surgery <sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup><\/li>\n<li>Reduced number of incisions<\/li><\/ul>\n<p>There has been a distinct lack of disclosure regarding nano-scale developments in keyhole surgery and remote medicine, a \"disparity of disclosure\" which does not correlate with the rapid advancements in both the medical and nanotechnology fields over the last two decades.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Robotic surgery has been touted as a solution to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Developing_country\" title=\"Developing country\" rel=\"external_link\" target=\"_blank\">underdeveloped nations<\/a>, whereby a single central hospital can operate several remote machines at distant locations. The potential for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">robotic surgery<\/a> has had strong military interest as well, with the intention of providing mobile <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care\" title=\"Health care\" rel=\"external_link\" target=\"_blank\">medical care<\/a> while keeping trained doctors safe from battle.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Non-robotic_hand_guided_assistance_systems\">Non-robotic hand guided assistance systems<\/span><\/h2>\n<p>There are also user-friendly non robotic assistance systems that are single hand guided devices with a high potential to save time and money. These assistance devices are not bound by the restrictions of common medical robotic systems. The systems enhance the manual possibilities of the surgeon and his\/her team, regarding the need of replacing static holding force during the intervention.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Some of the features are:<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<ul><li>The stabilisation of the camera picture because the whole static workload is conveyed by the assistance system.<\/li>\n<li>Some systems enable a fast repositioning and very short time for fixation of less than 0.02 seconds at the desired position. Some systems are lightweight constructions (18 kg) and can withstand a force of 20 N in any position and direction.<\/li>\n<li>The benefit \u2013 a physically relaxed intervention team can work concentrated on the main goals during the intervention.<\/li>\n<li>The potentials of these systems enhance the possibilities of the mobile medical care with those lightweight assistance systems. These assistance systems meet the demands of true solo surgery assistance systems and are robust, versatile, and easy to use.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:142px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Jacbaeus.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9d\/Jacbaeus.JPG\/140px-Jacbaeus.JPG\" width=\"140\" height=\"180\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Jacbaeus.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Hans Christian Jacobaeus<\/div><\/div><\/div>\n<p>It is difficult to credit one individual with the pioneering of the laparoscopic approach. In 1901, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Georg_Kelling\" title=\"Georg Kelling\" rel=\"external_link\" target=\"_blank\">Georg Kelling<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dresden\" title=\"Dresden\" rel=\"external_link\" target=\"_blank\">Dresden<\/a>, Germany, performed the first laparoscopic procedure in dogs, and, in 1910, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hans_Christian_Jacobaeus\" title=\"Hans Christian Jacobaeus\" rel=\"external_link\" target=\"_blank\">Hans Christian Jacobaeus<\/a> of Sweden performed the first laparoscopic operation in humans.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p><p>In the ensuing several decades, numerous individuals refined and popularized the approach further for laparoscopy. The advent of computer chip-based television cameras was a seminal event in the field of laparoscopy. This technological innovation provided the means to project a magnified view of the operative field onto a monitor and, at the same time, freed both the operating surgeon's hands, thereby facilitating performance of complex laparoscopic procedures. Prior to its conception, laparoscopy was a surgical approach with very few applications, mainly for purposes of diagnosis and performance of simple procedures in gynecologic applications.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>The first publication on modern diagnostic laparoscopy by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Raoul_Palmer\" title=\"Raoul Palmer\" rel=\"external_link\" target=\"_blank\">Raoul Palmer<\/a> appeared in 1947,<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> followed by the publication of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hans_Frangenheim\" title=\"Hans Frangenheim\" rel=\"external_link\" target=\"_blank\">Hans Frangenheim<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kurt_Semm\" title=\"Kurt Semm\" rel=\"external_link\" target=\"_blank\">Kurt Semm<\/a>. Hans Lindermann and Kurt Semm practised <span class=\"chemf nowrap\">CO<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">2<\/sub><\/span><\/span> hysteroscopy during the mid-1970s.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>In 1972, Clarke invented, published, patented, presented, and recorded on film laparoscopic surgery, with instruments marketed by the Ven Instrument Company of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Buffalo,_New_York\" title=\"Buffalo, New York\" rel=\"external_link\" target=\"_blank\">Buffalo, New York<\/a>.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p><p>In 1975, Tarasconi, from the Department of Ob-Gyn of the University of Passo Fundo Medical School (Passo Fundo, RS, Brazil), started his experience with organ resection by laparoscopy (Salpingectomy), first reported in the Third AAGL Meeting, Hyatt Regency Atlanta, November 1976 and later published in The Journal of Reproductive Medicine in 1981.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup>\n<p>This laparoscopic surgical procedure was the first laparoscopic organ resection reported in medical literature.\n<\/p>\n<\/p><p>In 1981, Semm, from the gynecological clinic of Kiel University, Germany, performed the first laparoscopic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Appendectomy\" title=\"Appendectomy\" rel=\"external_link\" target=\"_blank\">appendectomy<\/a>. Following his lecture on laparoscopic appendectomy, the president of the German Surgical Society wrote to the Board of Directors of the German Gynecological Society suggesting suspension of Semm from medical practice. Subsequently, Semm submitted a paper on laparoscopic appendectomy to the <i>American Journal of Obstetrics and Gynecology<\/i>, at first rejected as unacceptable for publication on the grounds that the technique reported on was \"unethical,\" but finally published in the journal <i>Endoscopy<\/i>.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<p>The abstract of his paper on endoscopic appendectomy can be found at here.\nSemm established several standard procedures that were regularly performed, such as ovarian cyst enucleation, myomectomy, treatment of ectopic pregnancy and finally laparoscopic-assisted vaginal hysterectomy (nowadays termed as cervical intra-fascial Semm hysterectomy). He also developed a medical instrument company Wisap in Munich, Germany, which still produces various endoscopic instruments of high quality. In 1985, he constructed the pelvi-trainer = laparo-trainer, a practical surgical model whereby colleagues could practice laparoscopic techniques. Semm published over 1000 papers in various journals.[4] He also produced over 30 endoscopic films and more than 20,000 colored slides to teach and inform interested colleagues about his technique. His first atlas, <i>More Details on Pelviscopy and Hysteroscopy<\/i> was published in 1976, a slide atlas on pelviscopy, hysteroscopy, and fetoscopy in 1979, and his books on gynecological endoscopic surgery in German, English, and many other languages in 1984, 1987, and 2002.\n<\/p>\n<\/p><p>Prior to 1990, the only specialty performing laparoscopy on a widespread basis was gynecology, mostly for relatively short, simple procedures such as a diagnostic laparoscopy or tubal ligation. The introduction in 1990 of a laparoscopic clip applier with twenty automatically advancing clips (rather than a single load clip applier that would have to be taken out, reloaded and reintroduced for each clip application) made general surgeons more comfortable with making the leap to laparoscopic cholecystectomies (gall bladder removal). On the other hand, some surgeons continue to use the single clip appliers as they save as much as $200 per case for the patient, detract nothing from the quality of the clip ligation, and add only seconds to case lengths. It must be noted that both laparoscopy tubal ligations and cholecystectomies may be performed using suturing and tying, thus further reducing the expensive cost of single and multiclips (when compared to suture). Once again this may increase case lengths but costs are greatly reduced (ideal for developing countries) and widespread accidents of loose clips are eliminated.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2013)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Gynecological_diagnosis\">Gynecological diagnosis<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fertiloscope\" title=\"Fertiloscope\" rel=\"external_link\" target=\"_blank\">Fertiloscope<\/a><\/div>\n<p>In gynecology, diagnostic laparoscopy may be used to inspect the outside of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uterus\" title=\"Uterus\" rel=\"external_link\" target=\"_blank\">uterus<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ovaries\" class=\"mw-redirect\" title=\"Ovaries\" rel=\"external_link\" target=\"_blank\">ovaries<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fallopian_tubes\" class=\"mw-redirect\" title=\"Fallopian tubes\" rel=\"external_link\" target=\"_blank\">fallopian tubes<\/a>, as, for example, in the diagnosis of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Female_infertility\" title=\"Female infertility\" rel=\"external_link\" target=\"_blank\">female infertility<\/a>. Usually, one incision is placed near the navel and a second near the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pubic_hair\" title=\"Pubic hair\" rel=\"external_link\" target=\"_blank\">pubic hairline<\/a>. A special type of laparoscope called a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fertiloscope\" title=\"Fertiloscope\" rel=\"external_link\" target=\"_blank\">fertiloscope<\/a>, which is modified for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transvaginal\" class=\"mw-disambig\" title=\"Transvaginal\" rel=\"external_link\" target=\"_blank\">transvaginal<\/a> application, can be used. A dye test may be performed to detect any blockage in the reproductive tract, wherein a dark blue dye is passed up through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervix\" title=\"Cervix\" rel=\"external_link\" target=\"_blank\">cervix<\/a> and is followed with the laparoscope through its passage out into the fallopian tubes to the ovaries.<sup id=\"rdp-ebb-cite_ref-medlineplus_1-1\" class=\"reference\"><a href=\"#cite_note-medlineplus-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroscopic_surgery\" class=\"mw-redirect\" title=\"Arthroscopic surgery\" rel=\"external_link\" target=\"_blank\">Arthroscopic surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparotomy\" title=\"Laparotomy\" rel=\"external_link\" target=\"_blank\">Laparotomy<\/a>, an older <a href=\"https:\/\/en.wikipedia.org\/wiki\/Open_surgery\" class=\"mw-redirect\" title=\"Open surgery\" rel=\"external_link\" target=\"_blank\">open surgery<\/a> technique for operations on the abdomen<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous\" title=\"Percutaneous\" rel=\"external_link\" target=\"_blank\">Percutaneous<\/a> (surgery)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Invasiveness_of_surgical_procedures\" class=\"mw-redirect\" title=\"Invasiveness of surgical procedures\" rel=\"external_link\" target=\"_blank\">Invasiveness of surgical procedures<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Natural_orifice_translumenal_endoscopic_surgery\" class=\"mw-redirect\" title=\"Natural orifice translumenal endoscopic surgery\" rel=\"external_link\" target=\"_blank\">Natural orifice translumenal endoscopic surgery<\/a> (NOTES)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Revision_weight_loss_surgery\" title=\"Revision weight loss surgery\" rel=\"external_link\" target=\"_blank\">Revision weight loss surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Single_port_laparoscopy\" class=\"mw-redirect\" title=\"Single port laparoscopy\" rel=\"external_link\" target=\"_blank\">Single port laparoscopy<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-medlineplus-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-medlineplus_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-medlineplus_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nlm.nih.gov\/medlineplus\/ency\/article\/007016.htm\" target=\"_blank\">MedlinePlus > Laparoscopy<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110726093257\/http:\/\/www.nlm.nih.gov\/medlineplus\/ency\/article\/007016.htm\" target=\"_blank\">Archived<\/a> 2011-07-26 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>. Update Date: 8\/21\/2009. Updated by: James Lee, MD \/\/ No longer valid <\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Mastery of Endoscopic and Laparoscopic Surgery W. Stephen, M.D. Eubanks; Steve Eubanks (Editor); Lee L., M.D. Swanstrom (Editor); Nathaniel J. Soper (Editor) Lippincott Williams & Wilkins 2nd Edition 2004<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gfmer.ch\/Books\/Endoscopy_book\/Ch07_Training_Lap.html\" target=\"_blank\">\"Training in diagnostic laparoscopy\"<\/a>. Gfmer.ch. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140714210530\/http:\/\/www.gfmer.ch\/Books\/Endoscopy_book\/Ch07_Training_Lap.html\" target=\"_blank\">Archived<\/a> from the original on July 14, 2014<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">October 10,<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Training+in+diagnostic+laparoscopy&rft.pub=Gfmer.ch&rft_id=http%3A%2F%2Fwww.gfmer.ch%2FBooks%2FEndoscopy_book%2FCh07_Training_Lap.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bhandarkar, Deepraj; Mittal, Gaurav; Shah, Rasik; Katara, Avinash; Udwadia, Tehemton E (January 1, 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3002000\" target=\"_blank\">\"Single-incision laparoscopic cholecystectomy: How I do it?\"<\/a>. <i>Journal of Minimal Access Surgery<\/i>. <b>7<\/b> (1): 17\u201323. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4103%2F0972-9941.72367\" target=\"_blank\">10.4103\/0972-9941.72367<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0972-9941\" target=\"_blank\">0972-9941<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3002000\" target=\"_blank\">3002000<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21197237\" target=\"_blank\">21197237<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Minimal+Access+Surgery&rft.atitle=Single-incision+laparoscopic+cholecystectomy%3A+How+I+do+it%3F&rft.volume=7&rft.issue=1&rft.pages=17-23&rft.date=2011-01-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3002000&rft.issn=0972-9941&rft_id=info%3Apmid%2F21197237&rft_id=info%3Adoi%2F10.4103%2F0972-9941.72367&rft.aulast=Bhandarkar&rft.aufirst=Deepraj&rft.au=Mittal%2C+Gaurav&rft.au=Shah%2C+Rasik&rft.au=Katara%2C+Avinash&rft.au=Udwadia%2C+Tehemton+E&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3002000&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jimenez-Rodr\u00edguez, RM; Segura-Sampedro, JJ (February 2016). \"Laparoscopic approach in gastrointestinal emergencies\". <i>World Journal of Gastroenterology<\/i>. <b>22<\/b> (9): 2701. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3748%2Fwjg.v22.i9.2701\" target=\"_blank\">10.3748\/wjg.v22.i9.2701<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=World+Journal+of+Gastroenterology&rft.atitle=Laparoscopic+approach+in+gastrointestinal+emergencies.&rft.volume=22&rft.issue=9&rft.pages=2701&rft.date=2016-02&rft_id=info%3Adoi%2F10.3748%2Fwjg.v22.i9.2701&rft.aulast=Jimenez-Rodr%C3%ADguez&rft.aufirst=RM&rft.au=Segura-Sampedro%2C+JJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Raveenthiran, V (October\u2013December 2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jiaps.com\/article.asp?issn=0971-9261;year=2010;volume=15;issue=4;spage=122;epage=128;aulast=Raveenthiran\" target=\"_blank\">\"Pediatric laparoscopy: Facts and factitious claims\"<\/a>. <i>J Indian Assoc Pediatr Surg<\/i>. <b>15<\/b> (4): 122\u2013126. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4103%2F0971-9261.72434\" target=\"_blank\">10.4103\/0971-9261.72434<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2995935\" target=\"_blank\">2995935<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21170193\" target=\"_blank\">21170193<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20170903120905\/http:\/\/www.jiaps.com\/article.asp?issn=0971-9261;year=2010;volume=15;issue=4;spage=122;epage=128;aulast=Raveenthiran\" target=\"_blank\">Archived<\/a> from the original on 2017-09-03.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Indian+Assoc+Pediatr+Surg&rft.atitle=Pediatric+laparoscopy%3A+Facts+and+factitious+claims&rft.volume=15&rft.issue=4&rft.pages=122-126&rft.date=2010-10%2F2010-12&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2995935&rft_id=info%3Apmid%2F21170193&rft_id=info%3Adoi%2F10.4103%2F0971-9261.72434&rft.aulast=Raveenthiran&rft.aufirst=V&rft_id=http%3A%2F%2Fwww.jiaps.com%2Farticle.asp%3Fissn%3D0971-9261%3Byear%3D2010%3Bvolume%3D15%3Bissue%3D4%3Bspage%3D122%3Bepage%3D128%3Baulast%3DRaveenthiran&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Westebring-van der Putten EP; Goossens RHM; Jakimowicz JJ; Dankelman J (2008). \"Haptics in Minimally Invasive Surgery \u2013 A Review\". <i>Minimally Invasive Therapy<\/i>. <b>17<\/b> (1): 3\u201316. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F13645700701820242\" target=\"_blank\">10.1080\/13645700701820242<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Minimally+Invasive+Therapy&rft.atitle=Haptics+in+Minimally+Invasive+Surgery+%E2%80%93+A+Review&rft.volume=17&rft.issue=1&rft.pages=3-16&rft.date=2008&rft_id=info%3Adoi%2F10.1080%2F13645700701820242&rft.au=Westebring-van+der+Putten+EP&rft.au=Goossens+RHM&rft.au=Jakimowicz+JJ&rft.au=Dankelman+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">A. G. Gallagher; N. McClure; J. McGuigan; K. Ritchie; N. P. Sheehy (2007). \"An Ergonomic Analysis of the Fulcrum Effect in the Acquisition of Endoscopic Skills\". <i>Endoscopy<\/i>. <b>1<\/b> (7): 617\u2013620. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1055%2Fs-2007-1001366\" target=\"_blank\">10.1055\/s-2007-1001366<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Endoscopy&rft.atitle=An+Ergonomic+Analysis+of+the+Fulcrum+Effect+in+the+Acquisition+of+Endoscopic+Skills&rft.volume=1&rft.issue=7&rft.pages=617-620&rft.date=2007&rft_id=info%3Adoi%2F10.1055%2Fs-2007-1001366&rft.au=A.+G.+Gallagher&rft.au=N.+McClure&rft.au=J.+McGuigan&rft.au=K.+Ritchie&rft.au=N.+P.+Sheehy&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Rodriguez, Anthony, Carpel Tunnel Surgery in Review, Beklind, 2009p.234<\/span>\n<\/li>\n<li id=\"cite_note-MayolGarcia-Aguilar1997-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-MayolGarcia-Aguilar1997_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mayol, Julio; Garcia-Aguilar, Julio; Ortiz-Oshiro, Elena; De-Diego Carmona, Jose A.; Fernandez-Represa, Jesus A. (1997). \"Risks of the Minimal Access Approach for Laparoscopic Surgery: Multivariate Analysis of Morbidity Related to Umbilical Trocar Insertion\". <i>World Journal of Surgery<\/i>. <b>21<\/b> (5): 529\u2013533. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2FPL00012281\" target=\"_blank\">10.1007\/PL00012281<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0364-2313\" target=\"_blank\">0364-2313<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=World+Journal+of+Surgery&rft.atitle=Risks+of+the+Minimal+Access+Approach+for+Laparoscopic+Surgery%3A+Multivariate+Analysis+of+Morbidity+Related+to+Umbilical+Trocar+Insertion&rft.volume=21&rft.issue=5&rft.pages=529-533&rft.date=1997&rft_id=info%3Adoi%2F10.1007%2FPL00012281&rft.issn=0364-2313&rft.aulast=Mayol&rft.aufirst=Julio&rft.au=Garcia-Aguilar%2C+Julio&rft.au=Ortiz-Oshiro%2C+Elena&rft.au=De-Diego+Carmona%2C+Jose+A.&rft.au=Fernandez-Represa%2C+Jesus+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mirhashemi R, Harlow BL, Ginsburg ES, Signorello LB, Berkowitz R, Feldman S (September 1998). \"Predicting risk of complications with gynecologic laparoscopic surgery\". <i>Obstet Gynecol<\/i>. <b>92<\/b> (3): 327\u201331. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0029-7844%2898%2900209-9\" target=\"_blank\">10.1016\/S0029-7844(98)00209-9<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9721764\" target=\"_blank\">9721764<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Obstet+Gynecol&rft.atitle=Predicting+risk+of+complications+with+gynecologic+laparoscopic+surgery&rft.volume=92&rft.issue=3&rft.pages=327-31&rft.date=1998-09&rft_id=info%3Adoi%2F10.1016%2FS0029-7844%2898%2900209-9&rft_id=info%3Apmid%2F9721764&rft.aulast=Mirhashemi&rft.aufirst=R&rft.au=Harlow%2C+BL&rft.au=Ginsburg%2C+ES&rft.au=Signorello%2C+LB&rft.au=Berkowitz%2C+R&rft.au=Feldman%2C+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Janie Fuller, DDS, (CAPT, USPHS), Walter Scott, Ph.D. (CAPT, USPHS), Binita Ashar, M.D., Julia Corrado, M.D. FDA, CDRH, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fda.gov\/cdrh\/medicaldevicesafety\/stamp\/trocar.html\" target=\"_blank\">\"Laparoscopic Trocar Injuries: A report from a U.S. Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH) Systematic Technology Assessment of Medical Products (STAMP) Committee\"<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070823235514\/http:\/\/www.fda.gov\/cdrh\/medicaldevicesafety\/stamp\/trocar.html\" target=\"_blank\">Archived<\/a> 2007-08-23 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.\n Finalized: November 7, 2003<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Peng Y, Zheng M, Ye Q, Chen X, Yu B, Liu B (January 2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0022-4804(08)00245-X\" target=\"_blank\">\"Heated and humidified <span class=\"chemf nowrap\">CO<span style=\"display:inline-block;margin-bottom:-0.3em;vertical-align:-0.4em;line-height:1em;font-size:80%;text-align:left\"><sup style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\"><\/sup><br \/><sub style=\"font-size:inherit;line-height:inherit;vertical-align:baseline\">2<\/sub><\/span><\/span> prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations\"<\/a>. <i>J. 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Archived from <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/link.springer.com\/article\/10.1007\/s10397-007\u20130338-x\" target=\"_blank\">the original<\/a> on 2013-07-11.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gynecological+Surgery&rft.atitle=Postoperative+abdominal+adhesions+and+their+prevention+in+gynaecological+surgery.+Expert+consensus+position&rft.volume=4&rft.issue=3&rft.pages=161-168&rft.date=2007-09&rft_id=info%3Adoi%2F10.1007%2Fs10397-007-0338-x&rft.aulast=DeWilde&rft.aufirst=Rudy+Leon&rft.au=Geoffrey+Trew&rft_id=https%3A%2F%2Flink.springer.com%2Farticle%2F10.1007%2Fs10397-007%E2%80%930338-x&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Lower, A.M.; R.J.S. 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Crowe (2004). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/humrep.oxfordjournals.org\/content\/19\/8\/1877.short\" target=\"_blank\">\"Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24\u2009046 patients\"<\/a>. <i>Human Reproduction<\/i>. <b>19<\/b> (8): 1877\u20131885. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Fhumrep%2Fdeh321\" target=\"_blank\">10.1093\/humrep\/deh321<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15178659\" target=\"_blank\">15178659<\/a>. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160208132713\/http:\/\/humrep.oxfordjournals.org\/content\/19\/8\/1877.short\" target=\"_blank\">Archived<\/a> from the original on 2016-02-08.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Human+Reproduction&rft.atitle=Adhesion-related+readmissions+following+gynaecological+laparoscopy+or+laparotomy+in+Scotland%3A+an+epidemiological+study+of+24%E2%80%89046+patients&rft.volume=19&rft.issue=8&rft.pages=1877-1885&rft.date=2004&rft_id=info%3Adoi%2F10.1093%2Fhumrep%2Fdeh321&rft_id=info%3Apmid%2F15178659&rft.aulast=Lower&rft.aufirst=A.M.&rft.au=R.J.S.+Hawthorn&rft.au=D.+Clark&rft.au=J.H.+Boyd&rft.au=A.R.+Finlayson&rft.au=A.D.+Knight&rft.au=A.M.+Crowe&rft_id=http%3A%2F%2Fhumrep.oxfordjournals.org%2Fcontent%2F19%2F8%2F1877.short&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Peng, Y; Zheng M; Ye Q; Chen X; Yu B; Liu B (Jan 2009). \"Heated and Humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations\". <i>J Surg Res<\/i>. <b>151<\/b> (1): 40\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jss.2008.03.039\" target=\"_blank\">10.1016\/j.jss.2008.03.039<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18639246\" target=\"_blank\">18639246<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Surg+Res&rft.atitle=Heated+and+Humidified+CO2+prevents+hypothermia%2C+peritoneal+injury%2C+and+intra-abdominal+adhesions+during+prolonged+laparoscopic+insufflations.&rft.volume=151&rft.issue=1&rft.pages=40-7&rft.date=2009-01&rft_id=info%3Adoi%2F10.1016%2Fj.jss.2008.03.039&rft_id=info%3Apmid%2F18639246&rft.aulast=Peng&rft.aufirst=Y&rft.au=Zheng+M&rft.au=Ye+Q&rft.au=Chen+X&rft.au=Yu+B&rft.au=Liu+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ahmed K, Keeling AN, Fakhry M, et al. 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Fertil.+Steril.&rft.atitle=Laparoscopy%E2%80%94new+instruments+for+suturing+and+ligation&rft.volume=23&rft.issue=4&rft.pages=274-7&rft.date=1972-04&rft_id=info%3Adoi%2F10.1016%2FS0015-0282%2816%2938886-0&rft_id=info%3Apmid%2F4258561&rft.au=Clarke+HC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Tarasconi JC (October 1981). \"Endoscopic salpingectomy\". <i>J Reprod Med<\/i>. <b>26<\/b> (10): 541\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6458700\" target=\"_blank\">6458700<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Reprod+Med&rft.atitle=Endoscopic+salpingectomy&rft.volume=26&rft.issue=10&rft.pages=541-5&rft.date=1981-10&rft_id=info%3Apmid%2F6458700&rft.au=Tarasconi+JC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Semm K (March 1983). \"Endoscopic Appendectomy\". <i>Endoscopy<\/i>. <b>15<\/b> (2): 59\u201364. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1055%2Fs-2007-1021466\" target=\"_blank\">10.1055\/s-2007-1021466<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6221925\" target=\"_blank\">6221925<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Endoscopy&rft.atitle=Endoscopic+Appendectomy&rft.volume=15&rft.issue=2&rft.pages=59-64&rft.date=1983-03&rft_id=info%3Adoi%2F10.1055%2Fs-2007-1021466&rft_id=info%3Apmid%2F6221925&rft.au=Semm+K&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALaparoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li>Feder, Barnaby J., <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2006\/03\/17\/business\/17spark.html\" target=\"_blank\">\"Surgical Device Poses a Rare but Serious Peril\"<\/a> <i>The New York Times<\/i>, March 17, 2006<\/li><\/ul>\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1325\nCached time: 20181216173846\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.600 seconds\nReal time usage: 0.747 seconds\nPreprocessor visited node count: 3651\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 159571\/2097152 bytes\nTemplate argument size: 6750\/2097152 bytes\nHighest expansion depth: 16\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 61816\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.333\/10.000 seconds\nLua memory usage: 6.63 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 623.648 1 -total\n<\/p>\n<pre>42.34% 264.059 1 Template:Reflist\n22.87% 142.659 18 Template:Cite_journal\n20.02% 124.861 10 Template:Citation_needed\n17.64% 109.984 10 Template:Fix\n12.23% 76.280 1 Template:Infobox_medical_intervention\n11.86% 73.981 1 Template:Cite_web\n11.45% 71.431 1 Template:Infobox\n 8.84% 55.132 20 Template:Category_handler\n 7.49% 46.683 10 Template:Delink\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:68469-1!canonical and timestamp 20181216173845 and revision id 874024329\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic_surgery\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214704\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.018 seconds\nReal time usage: 0.178 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 169.417 1 - wikipedia:Laparoscopic_surgery\n100.00% 169.417 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8568-0!*!*!*!*!*!* and timestamp 20181217214703 and revision id 24996\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Laparoscopic_surgery\">https:\/\/www.limswiki.org\/index.php\/Laparoscopic_surgery<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","bc5b7003f9b6b64085881e0e1ffa3d21_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/3a\/Blausen_0602_Laparoscopy_02.png\/560px-Blausen_0602_Laparoscopy_02.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Gallbladderop.jpg\/440px-Gallbladderop.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c3\/Laparoscopic_stomach_surgery.jpg\/440px-Laparoscopic_stomach_surgery.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b4\/Laparoscopic_Hand_Instruments_001_JPN.jpg\/440px-Laparoscopic_Hand_Instruments_001_JPN.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0d\/Laproscopic_Surgery_Robot.jpg\/440px-Laproscopic_Surgery_Robot.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9d\/Jacbaeus.JPG\/280px-Jacbaeus.JPG"],"bc5b7003f9b6b64085881e0e1ffa3d21_timestamp":1545083223,"94395468e1f4b75d1b8f25455b04879e_type":"article","94395468e1f4b75d1b8f25455b04879e_title":"Irreversible electroporation","94395468e1f4b75d1b8f25455b04879e_url":"https:\/\/www.limswiki.org\/index.php\/Irreversible_electroporation","94395468e1f4b75d1b8f25455b04879e_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tIrreversible electroporation\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs more medical references for verification or relies too heavily on primary sources. Please review the contents of the article and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. (August 2013)\nIrreversible electroporationSpecialtyoncology[edit on Wikidata]\nIrreversible electroporation (IRE or NTIRE for non-thermal irreversible electroporation) is a soft tissue ablation technique using ultra short but strong electrical fields to create permanent and hence lethal nanopores in the cell membrane, to disrupt the cellular homeostasis. The resulting cell death results from apoptosis and not necrosis as in all other thermal or radiation based ablation techniques. The main use of IRE lies in tumor ablation in regions where precision and conservation of the extracellular matrix, blood flow and nerves are of importance. The technique, in the form of the NanoKnife System, became commercially available for research purposes in 2009, solely for the surgical ablation of soft tissue tumors.[1]\n\nContents \n\n1 History \n2 Mechanism \n3 Potential advantages and disadvantages \n\n3.1 Advantages of IRE \n3.2 Disadvantages of IRE \n\n\n4 Use in medical practice \n5 Clinical trials \n6 Scope of applications \n\n6.1 Kidney \n6.2 Liver \n6.3 Pancreas \n6.4 Lung \n6.5 Prostate \n6.6 Coronary arteries \n6.7 Pulmonary veins \n6.8 Other organs \n\n\n7 References \n8 Further reading \n\n\nHistory \nFirst observations of IRE effects go back to 1898.[2] Nollet reported the first systematic observations of the appearance of red spots on animal and human skin that was exposed to electric sparks.[3] However, its use for modern medicine began in 1982 with the seminal work of Neumann and colleagues.[4] Pulsed electric fields were used to temporarily permeabilize cell membranes to deliver foreign DNA into cells. In the following decade, the combination of high-voltage pulsed electric fields with the chemotherapeutic drug bleomycin and with DNA yielded novel clinical applications: electrochemotherapy and gene electrotransfer, respectively.[5][6][7][8][9]\nIn these treatment modalities, IRE was an unwanted side effect to reversible electroporation. In 2005, Davalos et al. described the first study of a potential use of IRE.[10]\n\nMechanism \nFurther information: Electroporation \u00a7 Physical mechanism\nUtilizing ultra short pulsed but very strong electrical fields, micropores and nanopores are induced in the phospholipid bilayers which form the outer cell membranes. Two kinds of damage can occur:\n\nReversible electroporation (RE): Temporary and limited pathways for molecular transport via nanopores are formed, but after the end of the electric pulse, the transport ceases and the cells remain viable. Medical applications are, for example, local introduction of intracellular cytotoxic pharmaceuticals such as bleomycin (electroporation and electrochemotherapy).\nIrreversible electroporation (IRE): After a certain degree of damage to the cell membranes by electroporation, the leakage of intracellular contents is too severe or the resealing of the cellular membrane is too slow, leaving healthy and\/or cancerous cells irreversibly damaged. They die by apoptosis, which is unique to this ablation technique, in opposition to all other ablation systems which induce necrosis either by heat or radiation.\nIt should be stated that even though the ablation method is generally accepted to be apoptosis, some findings seem to contradict a pure apoptotic cell death, making the exact process by which IRE causes cell death unclear.[11]\nThe mechanism of IRE is not completely understood. The current theory is as follows:[12]\nWhen an electrical field of more than 0.5 V\/nm[13] is applied to the resting trans-membrane potential, it is proposed that water enters the cell during this dielectric breakdown. Hydrophilic pores are formed.[14][15] A molecular dynamics simulation by Tarek[16] illustrates this proposed pore formation in two steps:[12]\n\nAfter the application of an electrical field, water molecules line up in single file and penetrate the hydrophobic center of the bilayer lipid membrane.\nThese water channels continue to grow in length and diameter and expand into water-filled pores, at which point they are stabilized by the lipid head groups that move from the membrane-water interface to the middle of the bilayer.\nIt is proposed that as the applied electrical field increases, the greater is the perturbation of the phospholipid head groups, which in turn increases the number of water filled pores.[17] This entire process can occur within a few nanoseconds.[16] Average sizes of nanopores are likely cell-type specific. In swine livers, they average around 340-360 nm, as found using SEM.[12]\n\nPotential advantages and disadvantages \nAdvantages of IRE \nTissue selectivity - conservation of vital structures within the treatment field. Its capability of preserving vital structures within the IRE-ablated zone. In all IRE ablated liver tissues, critical structures, such as the hepatic arteries, hepatic veins, portal veins and intrahepatic bile ducts were all preserved. In IRE the cell death is mediated by apoptosis. Structures mainly consisting of proteins like vascular elastic and collagenous structures, as well as peri-cellular matrix proteins are not affected by the currents. Vital and scaffolding structures (like large blood vessels, urethra or intrahepatic bile ducts) are conserved.[18] The electrically insulating myelin layer, surrounding nerve fibers, protects nerve bundles from the IRE effects to a certain degree. Up to what point nerves stay unaffected or can regenerate is not completely understood.[19]\nSharp ablation zone margins- The transition zone between reversible electroporated area and irreversible electroporated area is accepted to be only a few cell layers. Whereas, the transition areas as in radiation or thermal based ablation techniques are non-existent. Further, the absence of the heat sink effect, which is a cause of many problems and treatment failures, is advantageous and increases the predictability of the treatment field. Geometrically, rather complex treatment fields are enabled by the multi-electrode concept.[20]\nAbsence of thermally induced necrosis - The short pulse lengths relative to the time between the pulses prevents joule heating of the tissue. Hence, by design, no necrotic cell damage is to be expected (except possibly in very close proximity to the needle). Therefore, IRE has none of the typical short and long term side-effects associated with necrosis.[21][22]\nShort treatment time - A typical treatment takes less than 5 minutes. This does not include the possibly complicated electrode placement.\nReal time monitoring - The treatment volume can be visualized, both during and after the treatment. Possible visualization methods are ultrasound, MRI, and CT.[20]\nDisadvantages of IRE \nStrong muscle contractions - The strong electric fields created by IRE, due to direct stimulation of the neuromuscular junction, cause strong muscle contractions requiring special anesthesia and total body paralysis.[23]\nIncomplete ablation within targeted tumors- The originally threshold for IRE of cells was approximately 600 V\/cm with 8 pulses, a pulse duration of 100 \u03bcs, and a frequency of 10 Hz.[24] Qin et al. later discovered that even at 1,300 V\/cm with 99 pulses, a pulse duration of 100 \u03bcs, and 10 Hz, there were still islands of viable tumor cells within ablated regions.[25] This suggests that tumor tissue may respond differently to IRE than healthy parenchyma. The mechanism of cell death following IRE relies on cellular apoptosis, which results from pore formation in the cellular membrane. Tumor cells, known to be resistant to apoptotic pathways, may require higher thresholds of energy to be adequately treated.\nLocal environment - The electric fields of IRE are strongly influenced by the conductivity of the local environment. The presence of metal, for example with biliary stents, can result in variances in energy deposition. Various organs, such as the kidneys, are also subject to irregular ablation zones, due to the increased conductivity of urine.[26]\nUse in medical practice \nA number of electrodes, in the form of long needles, are placed around the target volume. The point of penetration for the electrodes is chosen according to anatomical conditions. Imaging is essential to the placement and can be achieved by ultrasound, magnetic resonance imaging or tomography. The needles are then connected to the IRE-generator, which then proceeds to sequentially build up a potential difference between two electrodes. The geometry of the IRE-treatment field is calculated in real time and can be influenced by the user. Depending on the treatment-field and number of electrodes used, the ablation takes between 1 and 10 minutes. In general muscle relaxants are administered, since even under general anesthetics, strong muscle contractions are induced by excitation of the motor end-plate.\nTypical parameters:\n\nNumber of pulses per treatment: 90\nPulse length: 100 \u03bcs\nIntermission between pulses: 100 to 1000 ms\nField strength: 1500 volt\/cm\nCurrent: ca. 50 A (tissue- and geometry dependent)\nMax ablation volume using two electrodes: 4 \u00d7 3 \u00d7 2 cm\u00b3\nThe shortly pulsed, strong electrical fields are induced through thin, sterile, disposable electrodes. The potential differences are calculated and applied by a computer system between these electrodes in accordance to a previously planned treatment field.\nOne specific device for the IRE procedure is the NanoKnife system manufactured by AngioDynamics, which received FDA 510k clearance on October 24, 2011.[27] The NanoKnife system has also received an Investigational Device Exemption (IDE) from the FDA that allows AngioDynamics to conduct clinical trials using this device.[27] The Nanoknife system transmits a low-energy direct current from a generator to electrode probes placed in the target tissues for the surgical ablation of soft tissue. In 2011, AngioDynamics received an FDA warning letter for promoting the device for indications for which it had not received approval.[28]\nIn 2013, the UK National Institute for Health and Clinical Excellence issued a guidance that the safety and efficacy of the use of irreversible electroporation of the treatment of various types of cancer has not yet been established.[29]\n\nClinical trials \nNone of the potential organ systems, which may be treated for various conditions and tumors, are covered by randomized multicenter trials or long-term follow-ups.\nIn 2010, Ball and colleagues conducted a clinical trial evaluating IRE in 21 patients treated for metastatic or primary tumors of the liver, kidney, or lung. Two patients developed positional neurapraxia because of the extended arm position requested for CT scanning. Some patients developed self-limiting ventricular tachycardias, which are now minimized by using an electrocardiogram (ECG) synchronizer. Three patients developed pneumothorax as a result of needle electrode insertion. The authors concluded that an ECG synchronizer should be used to minimize the risk of arrhythmias and that attention to the position of the arms is required to maximize CT scan quality but minimize brachial plexus strain.[30]\nA larger, single-center, prospective, non-randomized, cohort study to investigate the safety of IRE for tumor ablation in humans evaluated 38 subjects with advanced malignancy of the liver, kidney, or lung (69 separate tumors) which were unresponsive to alternative treatment. The authors reported no mortalities within the 30 days post-procedure. Transient ventricular arrhythmia occurred in four patients; ECG synchronized delivery was subsequently used in the remaining 30 patients, with two further arrhythmias (supraventricular tachycardia and atrial fibrillation). There was one report of obstruction of the upper ureter after IRE, in addition to one report of the unintentional electroporation of an adrenal gland, resulting in a transient, severe hypertension. Two patients developed temporary neurapraxia secondary to arm extension during treatment, The authors further noted that complete target tumor ablation verified by CT was achieved in 46 of the 69 tumors treated with IRE (66%), while most treatment failures occurred in renal and lung tumors. The authors concluded that IRE appears safe for clinical use if ECG-synchronized delivery is utilized to prevent arrhythmias.[31]\n\nScope of applications \nKidney \nWhile nephron-sparing surgery is the gold standard treatment for small, malignant renal masses, ablative therapies are considered a viable option in patients who are poor surgical candidates. Radiofrequency ablation (RFA) and cryoablation have been used since the 1990s; however, in lesions larger than 3 cm, their efficacy is limited. The newer ablation modalities, such as IRE, microwave ablation (MWA), and high-intensity focused ultrasound, may help overcome the challenges in tumor size.[32]\nThe first human studies have proven the safety of IRE for the ablation of renal masses; however, the effectiveness of IRE through histopathological examination of an ablated renal tumor in humans is yet to be known. Wagstaff et al. have set out to investigate the safety and effectiveness of IRE ablation of renal masses and to evaluate the efficacy of ablation using MIR and contrast-enhanced ultrasound imaging. In accordance with the prospective protocol designed by the authors, the treated patients will subsequently undergo radical nephrectomy to assess IRE ablation success.[33]\n\nLiver \nThermal ablation techniques are very effective at treating liver tumors; however, many tumors are poorly amenable to thermal ablation due to their proximity to large blood vessels or major bile ducts, that render ablation ineffective or dangerous.[34]\nIn a single-center, prospective, non-randomized cohort, the safety of IRE of liver lesions was assessed in 25 patients. The authors reported a 50% tumor response rate, and noted that IRE failed to have any effect on tumors larger than 5 cm in any dimension. There were no reports of liver damage in any of the patients treated.[31] The trend of larger tumors being incompletely ablated using IRE has persisted across other studies.[35]\n\nPancreas \nPercutaneous thermal ablation of the pancreas was first described in 1999; however, subsequent review concluded that RFA in this setting has an unacceptably high complication rate without a clear benefit in survival.[36][37] The non-thermal mechanism of cell death from IRE and the safety and feasibility seen in animal models, suggests that it may be a more reasonable option.[38]\nMartin et al. evaluated overall survival in 54 patients with local pancreatic adenocarcinoma; they compared their IRE-treated cohort to matched stage III patients treated with standard therapy. They found a statistically significant increase in local progression-free survival, distant progression-free survival, and overall survival, amongst the patients treated with IRE.[39]\n\nLung \nIn a prospective, single-arm, multi-center, phase II clinical trial, the safety and efficacy of IRE on lung cancers were evaluated. The trial included patients with primary and secondary lung malignancies and preserved lung function. The expected effectiveness was not met at interim analysis and the trial was stopped prematurely. Complications included pneumothoraces (11 of 23 patients), alveolar hemorrhage not resulting in significant hemoptysis, and needle tract seeding was found in 3 cases (13%). Disease progression was seen in 14 of 23 patients (61%). Stable disease was found in 1 (4%), partial remission in 1 (4%) and complete remission in 7 (30%) patients. The authors concluded that IRE is not effective for the treatment of lung malignancies.[40] Similarly poor treatment outcomes have been observed in other studies.[31][41]\nA major obstacle of IRE in the lung is the difficulty in positioning the electrodes; placing the probes in parallel alignment is made challenging by the interposition of ribs. Additionally, the planned and actual ablation zones in the lung are dramatically different due to the differences in conductivity between tumor, lung parenchyma, and air.[42]\n\nProstate \nThe idea of treating prostate cancer with IRE was first proposed by Gary Onik and Boris Rubinsky in 2007.[43] Prostate carcinomas are frequently located near sensitive structures which might be permanently damaged by thermal treatments or radiation therapy. The applicability of surgical methods is often limited by accessibility and precision. Surgery is also associated with a long healing time and high rate of side effects.[44] Using IRE, the urethra, bladder, rectum and neurovascular bundle can potentially be included in the treatment field without creating (permanent) damage. This would potentially give IRE superiority both for focal therapy and whole gland treatments, as compared to all other available methods. Though treatments using IRE have been practiced successfully for more than three years, it has to be considered experimental since there are no multi-center studies or long-term follow-ups.\nThe first study including 16 patients (Gleason-Score ranging from 6 to 8) was released in 2010 by G. Onik and B. Rubinsky.[45] Most publicly and broadly, IRE has been used for prostate carcinomas by M. K. Stehling in Germany.[46] In the UK, Dickson et al. have been using IRE for Gleason 6 and 7 carcinomas and reported positively about its safety and low toxicity.[47]\n\nCoronary arteries \nMaor et el have demonstrated the safety and efficiency of IRE as an ablation modality for smooth muscle cells in the walls of large vessels in rat model.[48] Therefore, IRE has been suggested as preventive treatment for coronary artery re-stenosis after percutaneous coronary intervention.\n\nPulmonary veins \nNumerous studies in animals have demonstrated the safety and efficiency of IRE as a non-thermal ablation modality for pulmonary veins in context of atrial fibrillation treatment. IRE's advantages in comparison with RF-ablation and cryoablation are: well defined ablation area and the lack of peripheral thermal damage. Therefore, IRE has been suggested as a part of novel treatment for atrial fibrillation.[49]\n\nOther organs \nIRE has also been investigated in ex-vivo human eye models for treatment of uveal melanoma[50] and in thyroid cancer.[51]\nSuccessful ablations in animal tumor models have been conducted for lung,[52][53] brain,[54][55] heart,[56] skin,[57][58] bone,[59][60] head and neck cancer,[61] and blood vessels.[62]\n\nReferences \n\n\n^ Boutros, Cherif. \"Outcomes of Ablation of Unresectable Pancreatic Cancer Using the NanoKnife Irreversible Electroporation (IRE) System\". Clinical Trials.gov. US National Library of Medicine. Retrieved 26 December 2017 . \n\n^ Fuller GW (1898). Report on the investigations into the purification of the Ohio River water: at Louisville, Kentucky, made to the president and directors of the Louisville Water Company. (Report). Louisville Water Company (Louisville Ky.) \n\n^ Nollet JA (1754). 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Current evidence on the safety and efficacy of irreversible electroporation for treating primary lung cancer and metastases in the lung is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. \n\n^ Ball, Christine; Thomson, Kenneth R.; Kavnoudias, Helen (2010). \"Irreversible Electroporation\". Anesthesia & Analgesia. 110 (5): 1305\u20131309. doi:10.1213\/ane.0b013e3181d27b30. PMID 20142349. \n\n^ a b c Thomson, Kenneth R.; Cheung, Wa; Ellis, Samantha J.; Federman, Dean; Kavnoudias, Helen; Loader-Oliver, Deirdre; Roberts, Stuart; Evans, Peter; Ball, Christine (May 2011). \"Investigation of the Safety of Irreversible Electroporation in Humans\". Journal of Vascular and Interventional Radiology. 22 (5): 611\u2013621. doi:10.1016\/j.jvir.2010.12.014. PMID 21439847. \n\n^ Olweny, Ephrem O.; Cadeddu, Jeffrey A. (2012). \"Novel methods for renal tissue ablation\". 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PMID 19560023. \n\n^ Cannon, Robert; Ellis, Susan; Hayes, David; Narayanan, Govindarajan; Martin, Robert C.G. (2013-04-01). \"Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures\". Journal of Surgical Oncology. 107 (5): 544\u2013549. doi:10.1002\/jso.23280. ISSN 1096-9098. PMID 23090720. \n\n^ Goldberg, S. N.; Mallery, S.; Gazelle, G. S.; Brugge, W. R. (1999-09-01). \"EUS-guided radiofrequency ablation in the pancreas: results in a porcine model\". Gastrointestinal Endoscopy. 50 (3): 392\u2013401. doi:10.1053\/ge.1999.v50.98847. ISSN 0016-5107. PMID 10462663. \n\n^ Pezzilli, Raffaele; Serra, Carla; Ricci, Claudio; Casadei, Riccardo; Monari, Francesco; D'Ambra, Marielda; Minni, Francesco (2011-01-01). \"Radiofrequency ablation for advanced ductal pancreatic carcinoma: is this approach beneficial for our patients? A systematic review\". Pancreas. 40 (1): 163\u2013165. doi:10.1097\/MPA.0b013e3181eab751. ISSN 1536-4828. PMID 21160378. \n\n^ Bower, Matthew; Sherwood, Leslie; Li, Yan; Martin, Robert (2011-07-01). \"Irreversible electroporation of the pancreas: Definitive local therapy without systemic effects\". Journal of Surgical Oncology. 104 (1): 22\u201328. doi:10.1002\/jso.21899. ISSN 1096-9098. PMID 21360714. \n\n^ Martin, Robert C. G.; McFarland, Kelli; Ellis, Susan; Velanovich, Vic (2013-12-01). \"Irreversible electroporation in locally advanced pancreatic cancer: potential improved overall survival\". Annals of Surgical Oncology. 20 Suppl 3: S443\u2013449. doi:10.1245\/s10434-012-2736-1. ISSN 1534-4681. PMID 23128941. \n\n^ Ricke, Jens; J\u00fcrgens, Julian H. W.; Deschamps, Frederic; Tselikas, Lambros; Uhde, Katja; Kosiek, Ortrud; Baere, Thierry De (2015-01-22). \"Irreversible Electroporation (IRE) Fails to Demonstrate Efficacy in a Prospective Multicenter Phase II Trial on Lung Malignancies: The ALICE Trial\". CardioVascular and Interventional Radiology. 38 (2): 401\u2013408. doi:10.1007\/s00270-014-1049-0. ISSN 0174-1551. PMID 25609208. \n\n^ Usman, Mumal; Moore, William; Talati, Ronak; Watkins, Kevin; Bilfinger, Thomas V. (2012-06-01). \"Irreversible electroporation of lung neoplasm: a case series\". Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 18 (6): CS43\u201347. doi:10.12659\/msm.882888. ISSN 1643-3750. PMC 3560719 . PMID 22648257. \n\n^ Srimathveeravalli G, Wimmer T, Silk M; et al. (2013). \"Treatment planning considerations for IRE in the lung: placement of needle electrodes is critical\". J Vasc Interv Radiol. 24 (4): S22. doi:10.1016\/j.jvir.2013.01.047. CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link) \n\n^ Onik, Gary; Mikus, Paul; Rubinsky, Boris (2007-08-01). \"Irreversible electroporation: implications for prostate ablation\". Technology in Cancer Research & Treatment. 6 (4): 295\u2013300. doi:10.1177\/153303460700600405. ISSN 1533-0346. PMID 17668936. \n\n^ Kasivisvanathan, V.; Emberton, M.; Ahmed, H. U. (2013-08-01). \"Focal therapy for prostate cancer: rationale and treatment opportunities\". Clinical Oncology. 25 (8): 461\u2013473. doi:10.1016\/j.clon.2013.05.002. ISSN 1433-2981. PMC 4042323 . PMID 23759249. \n\n^ Onik G, Rubinsky B (2009). \"Irreversible electroporation: first patient experience focal therapy of prostate cancer\". In Rubinsky B. Irreversible Electroporation (Series in Biomedical Engineering). Berlin: Springer. pp. 235\u2013247. ISBN 3-642-05419-6. \n\n^ M. K. Stehling: Adjunct Associate Professor of Radiology. Boston University School of Medicine \n\n^ Dickinson, C.L.; Valerio, M.; Ahmed, H.U.; Freeman, A.; Allen, C.; Emberton, M. (2013). \"584 Early clinical experience of focal therapy for localised prostate cancer using irreversible electroporation\". European Urology Supplements. 12 (1): e584. doi:10.1016\/s1569-9056(13)61067-2. \n\n^ Maor, Elad; Ivorra, Antoni; Rubinsky, Boris (2009-03-09). \"Non Thermal Irreversible Electroporation: Novel Technology for Vascular Smooth Muscle Cells Ablation\". PLoS ONE. 4 (3): e4757. doi:10.1371\/journal.pone.0004757. PMC 2650260 . PMID 19270746. \n\n^ Xie, Fei; Varghese, Frency; Pakhomov, Andrei G.; Semenov, Iurii; Xiao, Shu; Philpott, Jonathan; Zemlin, Christian (2015-12-14). \"Ablation of Myocardial Tissue With Nanosecond Pulsed Electric Fields\". PLoS ONE. 10 (12): e0144833. doi:10.1371\/journal.pone.0144833. PMC 4687652 . PMID 26658139. \n\n^ Mandel, Yossi; Laufer, Shlomi; Belkin, Michael; Rubinsky, Boris; Pe'er, Jacob; Frenkel, Shahar (2013-01-01). \"Irreversible electroporation of human primary uveal melanoma in enucleated eyes\". PLoS One. 8 (9): e71789. doi:10.1371\/journal.pone.0071789. ISSN 1932-6203. PMC 3764134 . PMID 24039721. \n\n^ Meijerink, Martijn R.; Scheffer, Hester J.; de Bree, Remco; Sedee, Robert-Jan (2015-08-01). \"Percutaneous Irreversible Electroporation for Recurrent Thyroid Cancer--A Case Report\". Journal of Vascular and Interventional Radiology: JVIR. 26 (8): 1180\u20131182. doi:10.1016\/j.jvir.2015.05.004. ISSN 1535-7732. PMID 26210244. \n\n^ Deodhar, Ajita; Monette, S\u00e9bastien; Jr, Gordon W. Single; Jr, William C. Hamilton; Thornton, Raymond H.; Sofocleous, Constantinos T.; Maybody, Majid; Solomon, Stephen B. (2011-03-31). \"Percutaneous Irreversible Electroporation Lung Ablation: Preliminary Results in a Porcine Model\". CardioVascular and Interventional Radiology. 34 (6): 1278\u20131287. doi:10.1007\/s00270-011-0143-9. ISSN 0174-1551. PMID 21455641. \n\n^ Dupuy, Damian E.; Aswad, Bassam; Ng, Thomas (2010-12-30). \"Irreversible Electroporation in a Swine Lung Model\". CardioVascular and Interventional Radiology. 34 (2): 391\u2013395. doi:10.1007\/s00270-010-0091-9. ISSN 0174-1551. PMID 21191587. \n\n^ Garcia, P. A.; Pancotto, T.; Rossmeisl, J. H.; Henao-Guerrero, N.; Gustafson, N. R.; Daniel, G. B.; Robertson, J. L.; Ellis, T. L.; Davalos, R. V. (2011-02-01). \"Non-Thermal Irreversible Electroporation (N-TIRE) and Adjuvant Fractionated Radiotherapeutic Multimodal Therapy for Intracranial Malignant Glioma in a Canine Patient\". Technology in Cancer Research & Treatment. 10 (1): 73\u201383. doi:10.7785\/tcrt.2012.500181. ISSN 1533-0346. PMC 4527477 . PMID 21214290. \n\n^ Garcia, Paulo A.; Jr, John H. Rossmeisl; Ii, Robert E. Neal; Ellis, Thomas L.; Olson, John D.; Henao-Guerrero, Natalia; Robertson, John; Davalos, Rafael V. (2010-07-29). \"Intracranial Nonthermal Irreversible Electroporation: In Vivo Analysis\". The Journal of Membrane Biology. 236 (1): 127\u2013136. CiteSeerX 10.1.1.679.527 . doi:10.1007\/s00232-010-9284-z. ISSN 0022-2631. PMID 20668843. \n\n^ Lavee, Jacob; Onik, Gary; Mikus, Paul; Rubinsky, Boris (2007). \"A Novel Nonthermal Energy Source for Surgical Epicardial Atrial Ablation: Irreversible Electroporation\". The Heart Surgery Forum. 10 (2): E162\u2013E167. doi:10.1532\/hsf98.20061202. PMID 17597044. \n\n^ Al-Sakere, Bassim; Andr\u00e9, Franck; Bernat, Claire; Connault, Elisabeth; Opolon, Paule; Davalos, Rafael V.; Rubinsky, Boris; Mir, Lluis M. (2007-11-07). \"Tumor Ablation with Irreversible Electroporation\". PLoS ONE. 2 (11): e1135. doi:10.1371\/journal.pone.0001135. PMC 2065844 . PMID 17989772. \n\n^ Calmels, L.; Al-Sakere, B.; Ruaud, J.-P.; Leroy-Willig, A.; Mir, L. M. (2012-12-01). \"In vivo MRI Follow-up of Murine Tumors Treated by Electrochemotherapy and other Electroporation-based Treatments\". Technology in Cancer Research & Treatment. 11 (6): 561\u2013570. doi:10.7785\/tcrt.2012.500270. ISSN 1533-0346. PMID 22712607. \n\n^ Fini, M.; Tschon, M.; Ronchetti, M.; Cavani, F.; Bianchi, G.; Mercuri, M.; Alberghini, M.; Cadossi, R. (2010-11-01). \"Ablation of bone cells by electroporation\". Bone & Joint Journal. 92-B (11): 1614\u20131620. doi:10.1302\/0301-620X.92B11.24664. ISSN 2049-4394. PMID 21037363. \n\n^ Fini M, Tschon M, Alberghini M, Bianchi G, Mercuri M, Campanacci L, Cavani F, Ronchett, de Terlizzi M, Cadossi R (2011). \"Cell electroporation in bone tissue\". In Lee E, Kee S, Gehl J. Clinical Aspects of Electroporation. Berlin: Springer. pp. 115\u2013127. ISBN 1-4419-8362-7. \n\n^ Wong D, Lee EW, Kee ST (2011). \"Translational research on irreversible electroporation: VX2 rabbit head and neck\". In Lee E, Kee S, Gehl J. Clinical Aspects of Electroporation. Berlin: Springer. pp. 231\u2013236. ISBN 1-4419-8362-7. \n\n^ Maor, Elad; Ivorra, Antoni; Rubinsky, Boris (2009-01-01). \"Non thermal irreversible electroporation: novel technology for vascular smooth muscle cells ablation\". PLoS One. 4 (3): e4757. doi:10.1371\/journal.pone.0004757. ISSN 1932-6203. PMC 2650260 . PMID 19270746. \n\n\nFurther reading \n\nRubinsky B (2009). Irreversible Electroporation (Series in Biomedical Engineering). Berlin: Springer. ISBN 978-3-642-05419-8. \n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Irreversible_electroporation\">https:\/\/www.limswiki.org\/index.php\/Irreversible_electroporation<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 23:08.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 650 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","94395468e1f4b75d1b8f25455b04879e_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Irreversible_electroporation skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Irreversible electroporation<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p><b>Irreversible electroporation<\/b> (<b>IRE<\/b> or <b>NTIRE<\/b> for <i><b>non-thermal irreversible electroporation<\/b><\/i>) is a soft tissue <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ablation#Medicine\" title=\"Ablation\" rel=\"external_link\" target=\"_blank\">ablation<\/a> technique using ultra short but strong <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electric_field\" title=\"Electric field\" rel=\"external_link\" target=\"_blank\">electrical fields<\/a> to create permanent and hence lethal nanopores in the cell membrane, to disrupt the cellular homeostasis. The resulting cell death results from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Apoptosis\" title=\"Apoptosis\" rel=\"external_link\" target=\"_blank\">apoptosis<\/a> and not <a href=\"https:\/\/en.wikipedia.org\/wiki\/Necrosis\" title=\"Necrosis\" rel=\"external_link\" target=\"_blank\">necrosis<\/a> as in all other thermal or radiation based ablation techniques. The main use of IRE lies in tumor ablation in regions where precision and conservation of the extracellular matrix, blood flow and nerves are of importance. The technique, in the form of the NanoKnife System, became commercially available for research purposes in 2009, solely for the surgical ablation of soft tissue tumors.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>First observations of IRE effects go back to 1898.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> Nollet reported the first systematic observations of the appearance of red spots on animal and human skin that was exposed to electric sparks.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> However, its use for modern medicine began in 1982 with the seminal work of Neumann and colleagues.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Pulsed electric fields were used to temporarily permeabilize cell membranes to deliver foreign DNA into cells. In the following decade, the combination of high-voltage pulsed electric fields with the chemotherapeutic drug bleomycin and with DNA yielded novel clinical applications: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrochemotherapy\" title=\"Electrochemotherapy\" rel=\"external_link\" target=\"_blank\">electrochemotherapy<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gene_electrotransfer\" class=\"mw-redirect\" title=\"Gene electrotransfer\" rel=\"external_link\" target=\"_blank\">gene electrotransfer<\/a>, respectively.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p><p>In these treatment modalities, IRE was an unwanted side effect to reversible electroporation. In 2005, Davalos et al. described the first study of a potential use of IRE.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Mechanism\">Mechanism<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electroporation#Physical_mechanism\" title=\"Electroporation\" rel=\"external_link\" target=\"_blank\">Electroporation \u00a7 Physical mechanism<\/a><\/div>\n<p>Utilizing ultra short pulsed but very strong electrical fields, micropores and nanopores are induced in the phospholipid bilayers which form the outer cell membranes. Two kinds of damage can occur:\n<\/p>\n<ol><li>Reversible electroporation (RE): Temporary and limited pathways for molecular transport via nanopores are formed, but after the end of the electric pulse, the transport ceases and the cells remain viable. Medical applications are, for example, local introduction of intracellular cytotoxic pharmaceuticals such as bleomycin (electroporation and electrochemotherapy).<\/li>\n<li>Irreversible electroporation (IRE): After a certain degree of damage to the cell membranes by electroporation, the leakage of intracellular contents is too severe or the resealing of the cellular membrane is too slow, leaving healthy and\/or cancerous cells irreversibly damaged. They die by apoptosis, which is unique to this ablation technique, in opposition to all other ablation systems which induce necrosis either by heat or radiation.<\/li><\/ol>\n<p>It should be stated that even though the ablation method is generally accepted to be apoptosis, some findings seem to contradict a pure apoptotic cell death, making the exact process by which IRE causes cell death unclear.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>The mechanism of IRE is not completely understood. The current theory is as follows:<sup id=\"rdp-ebb-cite_ref-:0_12-0\" class=\"reference\"><a href=\"#cite_note-:0-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p>When an electrical field of more than 0.5 V\/nm<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> is applied to the resting trans-membrane potential, it is proposed that water enters the cell during this dielectric breakdown. Hydrophilic pores are formed.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> A molecular dynamics simulation by Tarek<sup id=\"rdp-ebb-cite_ref-:1_16-0\" class=\"reference\"><a href=\"#cite_note-:1-16\" rel=\"external_link\">[16]<\/a><\/sup> illustrates this proposed pore formation in two steps:<sup id=\"rdp-ebb-cite_ref-:0_12-1\" class=\"reference\"><a href=\"#cite_note-:0-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<ol><li>After the application of an electrical field, water molecules line up in single file and penetrate the hydrophobic center of the bilayer lipid membrane.<\/li>\n<li>These water channels continue to grow in length and diameter and expand into water-filled pores, at which point they are stabilized by the lipid head groups that move from the membrane-water interface to the middle of the bilayer.<\/li><\/ol>\n<p>It is proposed that as the applied electrical field increases, the greater is the perturbation of the phospholipid head groups, which in turn increases the number of water filled pores.<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> This entire process can occur within a few nanoseconds.<sup id=\"rdp-ebb-cite_ref-:1_16-1\" class=\"reference\"><a href=\"#cite_note-:1-16\" rel=\"external_link\">[16]<\/a><\/sup> Average sizes of nanopores are likely cell-type specific. In swine livers, they average around 340-360 nm, as found using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scanning_electron_microscopy\" class=\"mw-redirect\" title=\"Scanning electron microscopy\" rel=\"external_link\" target=\"_blank\">SEM<\/a>.<sup id=\"rdp-ebb-cite_ref-:0_12-2\" class=\"reference\"><a href=\"#cite_note-:0-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Potential_advantages_and_disadvantages\">Potential advantages and disadvantages<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Advantages_of_IRE\">Advantages of IRE<\/span><\/h3>\n<ol><li>Tissue selectivity - conservation of vital structures within the treatment field. Its capability of preserving vital structures within the IRE-ablated zone. In all IRE ablated liver tissues, critical structures, such as the hepatic arteries, hepatic veins, portal veins and intrahepatic bile ducts were all preserved. In IRE the cell death is mediated by apoptosis. Structures mainly consisting of proteins like vascular elastic and collagenous structures, as well as peri-cellular matrix proteins are not affected by the currents. Vital and scaffolding structures (like large blood vessels, urethra or intrahepatic bile ducts) are conserved.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> The electrically insulating myelin layer, surrounding nerve fibers, protects nerve bundles from the IRE effects to a certain degree. Up to what point nerves stay unaffected or can regenerate is not completely understood.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup><\/li>\n<li>Sharp ablation zone margins- The transition zone between reversible electroporated area and irreversible electroporated area is accepted to be only a few cell layers. Whereas, the transition areas as in radiation or thermal based ablation techniques are non-existent. Further, the absence of the heat sink effect, which is a cause of many problems and treatment failures, is advantageous and increases the predictability of the treatment field. Geometrically, rather complex treatment fields are enabled by the multi-electrode concept.<sup id=\"rdp-ebb-cite_ref-:2_20-0\" class=\"reference\"><a href=\"#cite_note-:2-20\" rel=\"external_link\">[20]<\/a><\/sup><\/li>\n<li>Absence of thermally induced necrosis - The short pulse lengths relative to the time between the pulses prevents joule heating of the tissue. Hence, by design, no necrotic cell damage is to be expected (except possibly in very close proximity to the needle). Therefore, IRE has none of the typical short and long term side-effects associated with necrosis.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup><\/li>\n<li>Short treatment time - A typical treatment takes less than 5 minutes. This does not include the possibly complicated electrode placement.<\/li>\n<li>Real time monitoring - The treatment volume can be visualized, both during and after the treatment. Possible visualization methods are ultrasound, MRI, and CT.<sup id=\"rdp-ebb-cite_ref-:2_20-1\" class=\"reference\"><a href=\"#cite_note-:2-20\" rel=\"external_link\">[20]<\/a><\/sup><\/li><\/ol>\n<h3><span class=\"mw-headline\" id=\"Disadvantages_of_IRE\">Disadvantages of IRE<\/span><\/h3>\n<ol><li>Strong muscle contractions - The strong electric fields created by IRE, due to direct stimulation of the neuromuscular junction, cause strong muscle contractions requiring special anesthesia and total body paralysis.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup><\/li>\n<li>Incomplete ablation within targeted tumors- The originally threshold for IRE of cells was approximately 600 V\/cm with 8 pulses, a pulse duration of 100 \u03bcs, and a frequency of 10 Hz.<sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup> Qin et al. later discovered that even at 1,300 V\/cm with 99 pulses, a pulse duration of 100 \u03bcs, and 10 Hz, there were still islands of viable tumor cells within ablated regions.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> This suggests that tumor tissue may respond differently to IRE than healthy parenchyma. The mechanism of cell death following IRE relies on cellular apoptosis, which results from pore formation in the cellular membrane. Tumor cells, known to be resistant to apoptotic pathways, may require higher thresholds of energy to be adequately treated.<\/li>\n<li>Local environment - The electric fields of IRE are strongly influenced by the conductivity of the local environment. The presence of metal, for example with biliary stents, can result in variances in energy deposition. Various organs, such as the kidneys, are also subject to irregular ablation zones, due to the increased conductivity of urine.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup><\/li><\/ol>\n<h2><span class=\"mw-headline\" id=\"Use_in_medical_practice\">Use in medical practice<\/span><\/h2>\n<p>A number of electrodes, in the form of long needles, are placed around the target volume. The point of penetration for the electrodes is chosen according to anatomical conditions. Imaging is essential to the placement and can be achieved by ultrasound, magnetic resonance imaging or tomography. The needles are then connected to the IRE-generator, which then proceeds to sequentially build up a potential difference between two electrodes. The geometry of the IRE-treatment field is calculated in real time and can be influenced by the user. Depending on the treatment-field and number of electrodes used, the ablation takes between 1 and 10 minutes. In general muscle relaxants are administered, since even under general anesthetics, strong muscle contractions are induced by excitation of the motor end-plate.\n<\/p><p>Typical parameters:\n<\/p>\n<ul><li>Number of pulses per treatment: 90<\/li>\n<li>Pulse length: 100 \u03bcs<\/li>\n<li>Intermission between pulses: 100 to 1000 ms<\/li>\n<li>Field strength: 1500 volt\/cm<\/li>\n<li>Current: ca. 50 A (tissue- and geometry dependent)<\/li>\n<li>Max ablation volume using two electrodes: 4 \u00d7 3 \u00d7 2 cm\u00b3<\/li><\/ul>\n<p>The shortly pulsed, strong electrical fields are induced through thin, sterile, disposable electrodes. The potential differences are calculated and applied by a computer system between these electrodes in accordance to a previously planned treatment field.\n<\/p><p>One specific device for the IRE procedure is the NanoKnife system manufactured by AngioDynamics, which received FDA 510k clearance on October 24, 2011.<sup id=\"rdp-ebb-cite_ref-ReferenceA_27-0\" class=\"reference\"><a href=\"#cite_note-ReferenceA-27\" rel=\"external_link\">[27]<\/a><\/sup> The NanoKnife system has also received an Investigational Device Exemption (IDE) from the FDA that allows AngioDynamics to conduct clinical trials using this device.<sup id=\"rdp-ebb-cite_ref-ReferenceA_27-1\" class=\"reference\"><a href=\"#cite_note-ReferenceA-27\" rel=\"external_link\">[27]<\/a><\/sup> The Nanoknife system transmits a low-energy direct current from a generator to electrode probes placed in the target tissues for the surgical ablation of soft tissue. In 2011, AngioDynamics received an FDA warning letter for promoting the device for indications for which it had not received approval.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup>\n<\/p><p>In 2013, the UK National Institute for Health and Clinical Excellence issued a guidance that the safety and efficacy of the use of irreversible electroporation of the treatment of various types of cancer has not yet been established.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Clinical_trials\">Clinical trials<\/span><\/h2>\n<p>None of the potential organ systems, which may be treated for various conditions and tumors, are covered by randomized multicenter trials or long-term follow-ups.\n<\/p><p>In 2010, Ball and colleagues conducted a clinical trial evaluating IRE in 21 patients treated for metastatic or primary tumors of the liver, kidney, or lung. Two patients developed positional <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurapraxia\" title=\"Neurapraxia\" rel=\"external_link\" target=\"_blank\">neurapraxia<\/a> because of the extended arm position requested for CT scanning. Some patients developed self-limiting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_tachycardias\" class=\"mw-redirect\" title=\"Ventricular tachycardias\" rel=\"external_link\" target=\"_blank\">ventricular tachycardias<\/a>, which are now minimized by using an electrocardiogram (ECG) synchronizer. Three patients developed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pneumothorax\" title=\"Pneumothorax\" rel=\"external_link\" target=\"_blank\">pneumothorax<\/a> as a result of needle electrode insertion. The authors concluded that an ECG synchronizer should be used to minimize the risk of arrhythmias and that attention to the position of the arms is required to maximize CT scan quality but minimize <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brachial_plexus\" title=\"Brachial plexus\" rel=\"external_link\" target=\"_blank\">brachial plexus<\/a> strain.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p><p>A larger, single-center, prospective, non-randomized, cohort study to investigate the safety of IRE for tumor ablation in humans evaluated 38 subjects with advanced malignancy of the liver, kidney, or lung (69 separate tumors) which were unresponsive to alternative treatment. The authors reported no mortalities within the 30 days post-procedure. Transient ventricular arrhythmia occurred in four patients; ECG synchronized delivery was subsequently used in the remaining 30 patients, with two further arrhythmias (supraventricular tachycardia and atrial fibrillation). There was one report of obstruction of the upper ureter after IRE, in addition to one report of the unintentional electroporation of an adrenal gland, resulting in a transient, severe hypertension. Two patients developed temporary neurapraxia secondary to arm extension during treatment, The authors further noted that complete target tumor ablation verified by CT was achieved in 46 of the 69 tumors treated with IRE (66%), while most treatment failures occurred in renal and lung tumors. The authors concluded that IRE appears safe for clinical use if ECG-synchronized delivery is utilized to prevent arrhythmias.<sup id=\"rdp-ebb-cite_ref-:3_31-0\" class=\"reference\"><a href=\"#cite_note-:3-31\" rel=\"external_link\">[31]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Scope_of_applications\">Scope of applications<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Kidney\">Kidney<\/span><\/h3>\n<p>While nephron-sparing surgery is the gold standard treatment for small, malignant renal masses, ablative therapies are considered a viable option in patients who are poor surgical candidates. Radiofrequency ablation (RFA) and cryoablation have been used since the 1990s; however, in lesions larger than 3 cm, their efficacy is limited. The newer ablation modalities, such as IRE, microwave ablation (MWA), and high-intensity focused ultrasound, may help overcome the challenges in tumor size.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/p><p>The first human studies have proven the safety of IRE for the ablation of renal masses; however, the effectiveness of IRE through histopathological examination of an ablated renal tumor in humans is yet to be known. Wagstaff et al. have set out to investigate the safety and effectiveness of IRE ablation of renal masses and to evaluate the efficacy of ablation using MIR and contrast-enhanced ultrasound imaging. In accordance with the prospective protocol designed by the authors, the treated patients will subsequently undergo radical nephrectomy to assess IRE ablation success.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Liver\">Liver<\/span><\/h3>\n<p>Thermal ablation techniques are very effective at treating liver tumors; however, many tumors are poorly amenable to thermal ablation due to their proximity to large blood vessels or major bile ducts, that render ablation ineffective or dangerous.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup>\n<\/p><p>In a single-center, prospective, non-randomized cohort, the safety of IRE of liver lesions was assessed in 25 patients. The authors reported a 50% tumor response rate, and noted that IRE failed to have any effect on tumors larger than 5 cm in any dimension. There were no reports of liver damage in any of the patients treated.<sup id=\"rdp-ebb-cite_ref-:3_31-1\" class=\"reference\"><a href=\"#cite_note-:3-31\" rel=\"external_link\">[31]<\/a><\/sup> The trend of larger tumors being incompletely ablated using IRE has persisted across other studies.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Pancreas\">Pancreas<\/span><\/h3>\n<p>Percutaneous thermal ablation of the pancreas was first described in 1999; however, subsequent review concluded that RFA in this setting has an unacceptably high complication rate without a clear benefit in survival.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup> The non-thermal mechanism of cell death from IRE and the safety and feasibility seen in animal models, suggests that it may be a more reasonable option.<sup id=\"rdp-ebb-cite_ref-38\" class=\"reference\"><a href=\"#cite_note-38\" rel=\"external_link\">[38]<\/a><\/sup>\n<\/p><p>Martin et al. evaluated overall survival in 54 patients with local pancreatic adenocarcinoma; they compared their IRE-treated cohort to matched stage III patients treated with standard therapy. They found a statistically significant increase in local progression-free survival, distant progression-free survival, and overall survival, amongst the patients treated with IRE.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Lung\">Lung<\/span><\/h3>\n<p>In a prospective, single-arm, multi-center, phase II clinical trial, the safety and efficacy of IRE on lung cancers were evaluated. The trial included patients with primary and secondary lung malignancies and preserved lung function. The expected effectiveness was not met at interim analysis and the trial was stopped prematurely. Complications included pneumothoraces (11 of 23 patients), alveolar hemorrhage not resulting in significant hemoptysis, and needle tract seeding was found in 3 cases (13%). Disease progression was seen in 14 of 23 patients (61%). Stable disease was found in 1 (4%), partial remission in 1 (4%) and complete remission in 7 (30%) patients. The authors concluded that IRE is not effective for the treatment of lung malignancies.<sup id=\"rdp-ebb-cite_ref-40\" class=\"reference\"><a href=\"#cite_note-40\" rel=\"external_link\">[40]<\/a><\/sup> Similarly poor treatment outcomes have been observed in other studies.<sup id=\"rdp-ebb-cite_ref-:3_31-2\" class=\"reference\"><a href=\"#cite_note-:3-31\" rel=\"external_link\">[31]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[41]<\/a><\/sup>\n<\/p><p>A major obstacle of IRE in the lung is the difficulty in positioning the electrodes; placing the probes in parallel alignment is made challenging by the interposition of ribs. Additionally, the planned and actual ablation zones in the lung are dramatically different due to the differences in conductivity between tumor, lung parenchyma, and air.<sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Prostate\">Prostate<\/span><\/h3>\n<p>The idea of treating prostate cancer with IRE was first proposed by Gary Onik and Boris Rubinsky in 2007.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup> Prostate carcinomas are frequently located near sensitive structures which might be permanently damaged by thermal treatments or radiation therapy. The applicability of surgical methods is often limited by accessibility and precision. Surgery is also associated with a long healing time and high rate of side effects.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup> Using IRE, the urethra, bladder, rectum and neurovascular bundle can potentially be included in the treatment field without creating (permanent) damage. This would potentially give IRE superiority both for focal therapy and whole gland treatments, as compared to all other available methods. Though treatments using IRE have been practiced successfully for more than three years, it has to be considered experimental since there are no multi-center studies or long-term follow-ups.\n<\/p><p>The first study including 16 patients (Gleason-Score ranging from 6 to 8) was released in 2010 by G. Onik and B. Rubinsky.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup> Most publicly and broadly, IRE has been used for prostate carcinomas by M. K. Stehling in Germany.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> In the UK, Dickson et al. have been using IRE for Gleason 6 and 7 carcinomas and reported positively about its safety and low toxicity.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Coronary_arteries\">Coronary arteries<\/span><\/h3>\n<p>Maor et el have demonstrated the safety and efficiency of IRE as an ablation modality for smooth muscle cells in the walls of large vessels in rat model.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup> Therefore, IRE has been suggested as preventive treatment for coronary artery re-stenosis after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous_coronary_intervention\" title=\"Percutaneous coronary intervention\" rel=\"external_link\" target=\"_blank\">percutaneous coronary intervention<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Pulmonary_veins\">Pulmonary veins<\/span><\/h3>\n<p>Numerous studies in animals have demonstrated the safety and efficiency of IRE as a non-thermal ablation modality for pulmonary veins in context of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_fibrillation\" title=\"Atrial fibrillation\" rel=\"external_link\" target=\"_blank\">atrial fibrillation<\/a> treatment. IRE's advantages in comparison with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiofrequency_ablation\" title=\"Radiofrequency ablation\" rel=\"external_link\" target=\"_blank\">RF-ablation<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cryoablation\" title=\"Cryoablation\" rel=\"external_link\" target=\"_blank\">cryoablation<\/a> are: well defined ablation area and the lack of peripheral thermal damage. Therefore, IRE has been suggested as a part of novel treatment for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atrial_fibrillation\" title=\"Atrial fibrillation\" rel=\"external_link\" target=\"_blank\">atrial fibrillation<\/a>.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Other_organs\">Other organs<\/span><\/h3>\n<p>IRE has also been investigated in ex-vivo human eye models for treatment of uveal melanoma<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup> and in thyroid cancer.<sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup>\n<\/p><p>Successful ablations in animal tumor models have been conducted for lung,<sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup> brain,<sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-55\" class=\"reference\"><a href=\"#cite_note-55\" rel=\"external_link\">[55]<\/a><\/sup> heart,<sup id=\"rdp-ebb-cite_ref-56\" class=\"reference\"><a href=\"#cite_note-56\" rel=\"external_link\">[56]<\/a><\/sup> skin,<sup id=\"rdp-ebb-cite_ref-57\" class=\"reference\"><a href=\"#cite_note-57\" rel=\"external_link\">[57]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-58\" class=\"reference\"><a href=\"#cite_note-58\" rel=\"external_link\">[58]<\/a><\/sup> bone,<sup id=\"rdp-ebb-cite_ref-59\" class=\"reference\"><a href=\"#cite_note-59\" rel=\"external_link\">[59]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-60\" class=\"reference\"><a href=\"#cite_note-60\" rel=\"external_link\">[60]<\/a><\/sup> head and neck cancer,<sup id=\"rdp-ebb-cite_ref-61\" class=\"reference\"><a href=\"#cite_note-61\" rel=\"external_link\">[61]<\/a><\/sup> and blood vessels.<sup id=\"rdp-ebb-cite_ref-62\" class=\"reference\"><a href=\"#cite_note-62\" rel=\"external_link\">[62]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Boutros, Cherif. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02041936\" target=\"_blank\">\"Outcomes of Ablation of Unresectable Pancreatic Cancer Using the NanoKnife Irreversible Electroporation (IRE) System\"<\/a>. <i>Clinical Trials.gov<\/i>. 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Oncol<\/i>. <b>26<\/b> (36): 5896\u2013903. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1200%2FJCO.2007.15.6794\" target=\"_blank\">10.1200\/JCO.2007.15.6794<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2645111\" target=\"_blank\">2645111<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19029422\" target=\"_blank\">19029422<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J.+Clin.+Oncol.&rft.atitle=%28Dec+2008%29.+Phase+I+trial+of+interleukin-12+plasmid++electroporation+in+patients+with+metastatic+melanoma&rft.volume=26&rft.issue=36&rft.pages=5896-903&rft.date=2008&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2645111&rft_id=info%3Apmid%2F19029422&rft_id=info%3Adoi%2F10.1200%2FJCO.2007.15.6794&rft.au=Daud+AI%2C+DeConti+RC%2C+Andrews+S%2C+Urbas+P%2C+Riker+AI&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2645111&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Explicit use of et al. 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(2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2989557\" target=\"_blank\">\"Irreversible Electroporation: A Novel Image-Guided Cancer Therapy\"<\/a>. <i>Gut and Liver<\/i>. <b>4<\/b> (Suppl.1): S99\u2013S104. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.5009%2Fgnl.2010.4.s1.s99\" target=\"_blank\">10.5009\/gnl.2010.4.s1.s99<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2989557\" target=\"_blank\">2989557<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21103304\" target=\"_blank\">21103304<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gut+and+Liver&rft.atitle=Irreversible+Electroporation%3A+A+Novel+Image-Guided+Cancer+Therapy&rft.volume=4&rft.issue=Suppl.1&rft.pages=S99-S104&rft.date=2010&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2989557&rft_id=info%3Apmid%2F21103304&rft_id=info%3Adoi%2F10.5009%2Fgnl.2010.4.s1.s99&rft.aulast=Lee&rft.aufirst=Edward+W.&rft.au=Thai%2C+Susan&rft.au=Kee%2C+Stephen+T.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2989557&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ii, Robert E. 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(2006-07-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ieeexplore.ieee.org\/lpdocs\/epic03\/wrapper.htm?arnumber=1643410\" target=\"_blank\">\"In vivo results of a new focal tissue ablation technique: irreversible electroporation\"<\/a>. <i>IEEE Transactions on Biomedical Engineering<\/i>. <b>53<\/b> (7): 1409\u20131415. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2FTBME.2006.873745\" target=\"_blank\">10.1109\/TBME.2006.873745<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0018-9294\" target=\"_blank\">0018-9294<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16830945\" target=\"_blank\">16830945<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=IEEE+Transactions+on+Biomedical+Engineering&rft.atitle=In+vivo+results+of+a+new+focal+tissue+ablation+technique%3A+irreversible+electroporation&rft.volume=53&rft.issue=7&rft.pages=1409-1415&rft.date=2006-07-01&rft.issn=0018-9294&rft_id=info%3Apmid%2F16830945&rft_id=info%3Adoi%2F10.1109%2FTBME.2006.873745&rft.aulast=Edd&rft.aufirst=J.F.&rft.au=Horowitz%2C+L.&rft.au=Davalos%2C+R.V.&rft.au=Mir%2C+L.M.&rft.au=Rubinsky%2C+B.&rft_id=http%3A%2F%2Fieeexplore.ieee.org%2Flpdocs%2Fepic03%2Fwrapper.htm%3Farnumber%3D1643410&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Arena, Christopher B; 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Current evidence on the safety and efficacy of irreversible electroporation for treating primary lung cancer and metastases in the lung is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research.<\/i><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ball, Christine; Thomson, Kenneth R.; Kavnoudias, Helen (2010). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/content.wkhealth.com\/linkback\/openurl?sid=WKPTLP:landingpage&an=00000539-201005000-00012\" target=\"_blank\">\"Irreversible Electroporation\"<\/a>. <i>Anesthesia & Analgesia<\/i>. <b>110<\/b> (5): 1305\u20131309. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1213%2Fane.0b013e3181d27b30\" target=\"_blank\">10.1213\/ane.0b013e3181d27b30<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20142349\" target=\"_blank\">20142349<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesia+%26+Analgesia&rft.atitle=Irreversible+Electroporation&rft.volume=110&rft.issue=5&rft.pages=1305-1309&rft.date=2010&rft_id=info%3Adoi%2F10.1213%2Fane.0b013e3181d27b30&rft_id=info%3Apmid%2F20142349&rft.aulast=Ball&rft.aufirst=Christine&rft.au=Thomson%2C+Kenneth+R.&rft.au=Kavnoudias%2C+Helen&rft_id=http%3A%2F%2Fcontent.wkhealth.com%2Flinkback%2Fopenurl%3Fsid%3DWKPTLP%3Alandingpage%26an%3D00000539-201005000-00012&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:3-31\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:3_31-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_31-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:3_31-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Thomson, Kenneth R.; Cheung, Wa; Ellis, Samantha J.; Federman, Dean; Kavnoudias, Helen; Loader-Oliver, Deirdre; Roberts, Stuart; Evans, Peter; Ball, Christine (May 2011). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1051044310011796\" target=\"_blank\">\"Investigation of the Safety of Irreversible Electroporation in Humans\"<\/a>. <i>Journal of Vascular and Interventional Radiology<\/i>. <b>22<\/b> (5): 611\u2013621. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jvir.2010.12.014\" target=\"_blank\">10.1016\/j.jvir.2010.12.014<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21439847\" target=\"_blank\">21439847<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Vascular+and+Interventional+Radiology&rft.atitle=Investigation+of+the+Safety+of+Irreversible+Electroporation+in+Humans&rft.volume=22&rft.issue=5&rft.pages=611-621&rft.date=2011-05&rft_id=info%3Adoi%2F10.1016%2Fj.jvir.2010.12.014&rft_id=info%3Apmid%2F21439847&rft.aulast=Thomson&rft.aufirst=Kenneth+R.&rft.au=Cheung%2C+Wa&rft.au=Ellis%2C+Samantha+J.&rft.au=Federman%2C+Dean&rft.au=Kavnoudias%2C+Helen&rft.au=Loader-Oliver%2C+Deirdre&rft.au=Roberts%2C+Stuart&rft.au=Evans%2C+Peter&rft.au=Ball%2C+Christine&rft_id=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1051044310011796&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Olweny, Ephrem O.; Cadeddu, Jeffrey A. (2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/content.wkhealth.com\/linkback\/openurl?sid=WKPTLP:landingpage&an=00042307-201209000-00007\" target=\"_blank\">\"Novel methods for renal tissue ablation\"<\/a>. <i>Current Opinion in Urology<\/i>. <b>22<\/b> (5): 379\u2013384. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2Fmou.0b013e328355ecf5\" target=\"_blank\">10.1097\/mou.0b013e328355ecf5<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22706069\" target=\"_blank\">22706069<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Current+Opinion+in+Urology&rft.atitle=Novel+methods+for+renal+tissue+ablation&rft.volume=22&rft.issue=5&rft.pages=379-384&rft.date=2012&rft_id=info%3Adoi%2F10.1097%2Fmou.0b013e328355ecf5&rft_id=info%3Apmid%2F22706069&rft.aulast=Olweny&rft.aufirst=Ephrem+O.&rft.au=Cadeddu%2C+Jeffrey+A.&rft_id=http%3A%2F%2Fcontent.wkhealth.com%2Flinkback%2Fopenurl%3Fsid%3DWKPTLP%3Alandingpage%26an%3D00042307-201209000-00007&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wagstaff, Peter GK; Bruin, Daniel M de; Zondervan, Patricia J; Heijink, C Dilara Savci; Engelbrecht, Marc RW; Delden, Otto M van; Leeuwen, Ton G van; Wijkstra, Hessel; Rosette, Jean JMCH de la (2015-03-22). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.biomedcentral.com\/1471-2407\/15\/165\" target=\"_blank\">\"The efficacy and safety of irreversible electroporation for the ablation of renal masses: a prospective, human, in-vivo study protocol\"<\/a>. <i>BMC Cancer<\/i>. <b>15<\/b> (1): 165. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2Fs12885-015-1189-x\" target=\"_blank\">10.1186\/s12885-015-1189-x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4376341\" target=\"_blank\">4376341<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25886058\" target=\"_blank\">25886058<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMC+Cancer&rft.atitle=The+efficacy+and+safety+of+irreversible+electroporation+for+the+ablation+of+renal+masses%3A+a+prospective%2C+human%2C+in-vivo+study+protocol&rft.volume=15&rft.issue=1&rft.pages=165&rft.date=2015-03-22&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4376341&rft_id=info%3Apmid%2F25886058&rft_id=info%3Adoi%2F10.1186%2Fs12885-015-1189-x&rft.aulast=Wagstaff&rft.aufirst=Peter+GK&rft.au=Bruin%2C+Daniel+M+de&rft.au=Zondervan%2C+Patricia+J&rft.au=Heijink%2C+C+Dilara+Savci&rft.au=Engelbrecht%2C+Marc+RW&rft.au=Delden%2C+Otto+M+van&rft.au=Leeuwen%2C+Ton+G+van&rft.au=Wijkstra%2C+Hessel&rft.au=Rosette%2C+Jean+JMCH+de+la&rft_id=http%3A%2F%2Fwww.biomedcentral.com%2F1471-2407%2F15%2F165&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gervais, Debra A.; Goldberg, S. Nahum; Brown, Daniel B.; Soulen, Michael C.; Millward, Steven F.; Rajan, Dheeraj K. (2009). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1051044309003261\" target=\"_blank\">\"Society of Interventional Radiology Position Statement on Percutaneous Radiofrequency Ablation for the Treatment of Liver Tumors\"<\/a>. <i>Journal of Vascular and Interventional Radiology<\/i>. <b>20<\/b> (7): S342\u2013S347. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.jvir.2009.04.029\" target=\"_blank\">10.1016\/j.jvir.2009.04.029<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19560023\" target=\"_blank\">19560023<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Vascular+and+Interventional+Radiology&rft.atitle=Society+of+Interventional+Radiology+Position+Statement+on+Percutaneous+Radiofrequency+Ablation+for+the+Treatment+of+Liver+Tumors&rft.volume=20&rft.issue=7&rft.pages=S342-S347&rft.date=2009&rft_id=info%3Adoi%2F10.1016%2Fj.jvir.2009.04.029&rft_id=info%3Apmid%2F19560023&rft.aulast=Gervais&rft.aufirst=Debra+A.&rft.au=Goldberg%2C+S.+Nahum&rft.au=Brown%2C+Daniel+B.&rft.au=Soulen%2C+Michael+C.&rft.au=Millward%2C+Steven+F.&rft.au=Rajan%2C+Dheeraj+K.&rft_id=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1051044309003261&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Cannon, Robert; Ellis, Susan; Hayes, David; Narayanan, Govindarajan; Martin, Robert C.G. (2013-04-01). \"Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures\". <i>Journal of Surgical Oncology<\/i>. <b>107<\/b> (5): 544\u2013549. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fjso.23280\" target=\"_blank\">10.1002\/jso.23280<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1096-9098\" target=\"_blank\">1096-9098<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23090720\" target=\"_blank\">23090720<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Surgical+Oncology&rft.atitle=Safety+and+early+efficacy+of+irreversible+electroporation+for+hepatic+tumors+in+proximity+to+vital+structures&rft.volume=107&rft.issue=5&rft.pages=544-549&rft.date=2013-04-01&rft.issn=1096-9098&rft_id=info%3Apmid%2F23090720&rft_id=info%3Adoi%2F10.1002%2Fjso.23280&rft.aulast=Cannon&rft.aufirst=Robert&rft.au=Ellis%2C+Susan&rft.au=Hayes%2C+David&rft.au=Narayanan%2C+Govindarajan&rft.au=Martin%2C+Robert+C.G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Goldberg, S. N.; Mallery, S.; Gazelle, G. S.; Brugge, W. R. (1999-09-01). \"EUS-guided radiofrequency ablation in the pancreas: results in a porcine model\". <i>Gastrointestinal Endoscopy<\/i>. <b>50<\/b> (3): 392\u2013401. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1053%2Fge.1999.v50.98847\" target=\"_blank\">10.1053\/ge.1999.v50.98847<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0016-5107\" target=\"_blank\">0016-5107<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10462663\" target=\"_blank\">10462663<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gastrointestinal+Endoscopy&rft.atitle=EUS-guided+radiofrequency+ablation+in+the+pancreas%3A+results+in+a+porcine+model&rft.volume=50&rft.issue=3&rft.pages=392-401&rft.date=1999-09-01&rft.issn=0016-5107&rft_id=info%3Apmid%2F10462663&rft_id=info%3Adoi%2F10.1053%2Fge.1999.v50.98847&rft.aulast=Goldberg&rft.aufirst=S.+N.&rft.au=Mallery%2C+S.&rft.au=Gazelle%2C+G.+S.&rft.au=Brugge%2C+W.+R.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pezzilli, Raffaele; Serra, Carla; Ricci, Claudio; Casadei, Riccardo; Monari, Francesco; D'Ambra, Marielda; Minni, Francesco (2011-01-01). \"Radiofrequency ablation for advanced ductal pancreatic carcinoma: is this approach beneficial for our patients? A systematic review\". <i>Pancreas<\/i>. <b>40<\/b> (1): 163\u2013165. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FMPA.0b013e3181eab751\" target=\"_blank\">10.1097\/MPA.0b013e3181eab751<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1536-4828\" target=\"_blank\">1536-4828<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21160378\" target=\"_blank\">21160378<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pancreas&rft.atitle=Radiofrequency+ablation+for+advanced+ductal+pancreatic+carcinoma%3A+is+this+approach+beneficial+for+our+patients%3F+A+systematic+review&rft.volume=40&rft.issue=1&rft.pages=163-165&rft.date=2011-01-01&rft.issn=1536-4828&rft_id=info%3Apmid%2F21160378&rft_id=info%3Adoi%2F10.1097%2FMPA.0b013e3181eab751&rft.aulast=Pezzilli&rft.aufirst=Raffaele&rft.au=Serra%2C+Carla&rft.au=Ricci%2C+Claudio&rft.au=Casadei%2C+Riccardo&rft.au=Monari%2C+Francesco&rft.au=D%27Ambra%2C+Marielda&rft.au=Minni%2C+Francesco&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-38\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-38\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bower, Matthew; Sherwood, Leslie; Li, Yan; Martin, Robert (2011-07-01). \"Irreversible electroporation of the pancreas: Definitive local therapy without systemic effects\". <i>Journal of Surgical Oncology<\/i>. <b>104<\/b> (1): 22\u201328. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2Fjso.21899\" target=\"_blank\">10.1002\/jso.21899<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1096-9098\" target=\"_blank\">1096-9098<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21360714\" target=\"_blank\">21360714<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Surgical+Oncology&rft.atitle=Irreversible+electroporation+of+the+pancreas%3A+Definitive+local+therapy+without+systemic+effects&rft.volume=104&rft.issue=1&rft.pages=22-28&rft.date=2011-07-01&rft.issn=1096-9098&rft_id=info%3Apmid%2F21360714&rft_id=info%3Adoi%2F10.1002%2Fjso.21899&rft.aulast=Bower&rft.aufirst=Matthew&rft.au=Sherwood%2C+Leslie&rft.au=Li%2C+Yan&rft.au=Martin%2C+Robert&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-39\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-39\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Martin, Robert C. G.; McFarland, Kelli; Ellis, Susan; Velanovich, Vic (2013-12-01). \"Irreversible electroporation in locally advanced pancreatic cancer: potential improved overall survival\". <i>Annals of Surgical Oncology<\/i>. 20 Suppl 3: S443\u2013449. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1245%2Fs10434-012-2736-1\" target=\"_blank\">10.1245\/s10434-012-2736-1<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1534-4681\" target=\"_blank\">1534-4681<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23128941\" target=\"_blank\">23128941<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Surgical+Oncology&rft.atitle=Irreversible+electroporation+in+locally+advanced+pancreatic+cancer%3A+potential+improved+overall+survival&rft.volume=20+Suppl+3&rft.pages=S443-449&rft.date=2013-12-01&rft.issn=1534-4681&rft_id=info%3Apmid%2F23128941&rft_id=info%3Adoi%2F10.1245%2Fs10434-012-2736-1&rft.aulast=Martin&rft.aufirst=Robert+C.+G.&rft.au=McFarland%2C+Kelli&rft.au=Ellis%2C+Susan&rft.au=Velanovich%2C+Vic&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-40\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-40\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ricke, Jens; J\u00fcrgens, Julian H. W.; Deschamps, Frederic; Tselikas, Lambros; Uhde, Katja; Kosiek, Ortrud; Baere, Thierry De (2015-01-22). \"Irreversible Electroporation (IRE) Fails to Demonstrate Efficacy in a Prospective Multicenter Phase II Trial on Lung Malignancies: The ALICE Trial\". <i>CardioVascular and Interventional Radiology<\/i>. <b>38<\/b> (2): 401\u2013408. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00270-014-1049-0\" target=\"_blank\">10.1007\/s00270-014-1049-0<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0174-1551\" target=\"_blank\">0174-1551<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25609208\" target=\"_blank\">25609208<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=CardioVascular+and+Interventional+Radiology&rft.atitle=Irreversible+Electroporation+%28IRE%29+Fails+to+Demonstrate+Efficacy+in+a+Prospective+Multicenter+Phase+II+Trial+on+Lung+Malignancies%3A+The+ALICE+Trial&rft.volume=38&rft.issue=2&rft.pages=401-408&rft.date=2015-01-22&rft.issn=0174-1551&rft_id=info%3Apmid%2F25609208&rft_id=info%3Adoi%2F10.1007%2Fs00270-014-1049-0&rft.aulast=Ricke&rft.aufirst=Jens&rft.au=J%C3%BCrgens%2C+Julian+H.+W.&rft.au=Deschamps%2C+Frederic&rft.au=Tselikas%2C+Lambros&rft.au=Uhde%2C+Katja&rft.au=Kosiek%2C+Ortrud&rft.au=Baere%2C+Thierry+De&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-41\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-41\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Usman, Mumal; Moore, William; Talati, Ronak; Watkins, Kevin; Bilfinger, Thomas V. (2012-06-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3560719\" target=\"_blank\">\"Irreversible electroporation of lung neoplasm: a case series\"<\/a>. <i>Medical Science Monitor: International Medical Journal of Experimental and Clinical Research<\/i>. <b>18<\/b> (6): CS43\u201347. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.12659%2Fmsm.882888\" target=\"_blank\">10.12659\/msm.882888<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1643-3750\" target=\"_blank\">1643-3750<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3560719\" target=\"_blank\">3560719<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22648257\" target=\"_blank\">22648257<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Medical+Science+Monitor%3A+International+Medical+Journal+of+Experimental+and+Clinical+Research&rft.atitle=Irreversible+electroporation+of+lung+neoplasm%3A+a+case+series&rft.volume=18&rft.issue=6&rft.pages=CS43-47&rft.date=2012-06-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3560719&rft.issn=1643-3750&rft_id=info%3Apmid%2F22648257&rft_id=info%3Adoi%2F10.12659%2Fmsm.882888&rft.aulast=Usman&rft.aufirst=Mumal&rft.au=Moore%2C+William&rft.au=Talati%2C+Ronak&rft.au=Watkins%2C+Kevin&rft.au=Bilfinger%2C+Thomas+V.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3560719&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-42\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Srimathveeravalli G, Wimmer T, Silk M; et al. 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(<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Explicit_use_of_et_al.\" title=\"Category:CS1 maint: Explicit use of et al.\" rel=\"external_link\" target=\"_blank\">link<\/a>) CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-43\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-43\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Onik, Gary; Mikus, Paul; Rubinsky, Boris (2007-08-01). \"Irreversible electroporation: implications for prostate ablation\". <i>Technology in Cancer Research & Treatment<\/i>. <b>6<\/b> (4): 295\u2013300. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F153303460700600405\" target=\"_blank\">10.1177\/153303460700600405<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1533-0346\" target=\"_blank\">1533-0346<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17668936\" target=\"_blank\">17668936<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Technology+in+Cancer+Research+%26+Treatment&rft.atitle=Irreversible+electroporation%3A+implications+for+prostate+ablation&rft.volume=6&rft.issue=4&rft.pages=295-300&rft.date=2007-08-01&rft.issn=1533-0346&rft_id=info%3Apmid%2F17668936&rft_id=info%3Adoi%2F10.1177%2F153303460700600405&rft.aulast=Onik&rft.aufirst=Gary&rft.au=Mikus%2C+Paul&rft.au=Rubinsky%2C+Boris&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-44\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-44\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kasivisvanathan, V.; Emberton, M.; Ahmed, H. U. (2013-08-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4042323\" target=\"_blank\">\"Focal therapy for prostate cancer: rationale and treatment opportunities\"<\/a>. <i>Clinical Oncology<\/i>. <b>25<\/b> (8): 461\u2013473. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.clon.2013.05.002\" target=\"_blank\">10.1016\/j.clon.2013.05.002<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1433-2981\" target=\"_blank\">1433-2981<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4042323\" target=\"_blank\">4042323<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23759249\" target=\"_blank\">23759249<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Oncology&rft.atitle=Focal+therapy+for+prostate+cancer%3A+rationale+and+treatment+opportunities&rft.volume=25&rft.issue=8&rft.pages=461-473&rft.date=2013-08-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4042323&rft.issn=1433-2981&rft_id=info%3Apmid%2F23759249&rft_id=info%3Adoi%2F10.1016%2Fj.clon.2013.05.002&rft.aulast=Kasivisvanathan&rft.aufirst=V.&rft.au=Emberton%2C+M.&rft.au=Ahmed%2C+H.+U.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4042323&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-45\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-45\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>Onik G, Rubinsky B (2009). \"Irreversible electroporation: first patient experience focal therapy of prostate cancer\". 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Laufer, Shlomi; Belkin, Michael; Rubinsky, Boris; Pe'er, Jacob; Frenkel, Shahar (2013-01-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3764134\" target=\"_blank\">\"Irreversible electroporation of human primary uveal melanoma in enucleated eyes\"<\/a>. <i>PLoS One<\/i>. <b>8<\/b> (9): e71789. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1371%2Fjournal.pone.0071789\" target=\"_blank\">10.1371\/journal.pone.0071789<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1932-6203\" target=\"_blank\">1932-6203<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3764134\" target=\"_blank\">3764134<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24039721\" target=\"_blank\">24039721<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=PLoS+One&rft.atitle=Irreversible+electroporation+of+human+primary+uveal+melanoma+in+enucleated+eyes&rft.volume=8&rft.issue=9&rft.pages=e71789&rft.date=2013-01-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3764134&rft.issn=1932-6203&rft_id=info%3Apmid%2F24039721&rft_id=info%3Adoi%2F10.1371%2Fjournal.pone.0071789&rft.aulast=Mandel&rft.aufirst=Yossi&rft.au=Laufer%2C+Shlomi&rft.au=Belkin%2C+Michael&rft.au=Rubinsky%2C+Boris&rft.au=Pe%27er%2C+Jacob&rft.au=Frenkel%2C+Shahar&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3764134&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-51\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-51\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Meijerink, Martijn R.; 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(2010-11-01). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bjj.boneandjoint.org.uk\/content\/92-B\/11\/1614\" target=\"_blank\">\"Ablation of bone cells by electroporation\"<\/a>. <i>Bone & Joint Journal<\/i>. <b>92-B<\/b> (11): 1614\u20131620. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1302%2F0301-620X.92B11.24664\" target=\"_blank\">10.1302\/0301-620X.92B11.24664<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2049-4394\" target=\"_blank\">2049-4394<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21037363\" target=\"_blank\">21037363<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Bone+%26+Joint+Journal&rft.atitle=Ablation+of+bone+cells+by+electroporation&rft.volume=92-B&rft.issue=11&rft.pages=1614-1620&rft.date=2010-11-01&rft.issn=2049-4394&rft_id=info%3Apmid%2F21037363&rft_id=info%3Adoi%2F10.1302%2F0301-620X.92B11.24664&rft.aulast=Fini&rft.aufirst=M.&rft.au=Tschon%2C+M.&rft.au=Ronchetti%2C+M.&rft.au=Cavani%2C+F.&rft.au=Bianchi%2C+G.&rft.au=Mercuri%2C+M.&rft.au=Alberghini%2C+M.&rft.au=Cadossi%2C+R.&rft_id=http%3A%2F%2Fwww.bjj.boneandjoint.org.uk%2Fcontent%2F92-B%2F11%2F1614&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-60\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-60\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>Fini M, Tschon M, Alberghini M, Bianchi G, Mercuri M, Campanacci L, Cavani F, Ronchett, de Terlizzi M, Cadossi R (2011). \"Cell electroporation in bone tissue\". In Lee E, Kee S, Gehl J. Clinical Aspects of Electroporation. Berlin: Springer. pp. 115\u2013127. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-4419-8362-7.<\/i><\/span>\n<\/li>\n<li id=\"cite_note-61\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-61\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>Wong D, Lee EW, Kee ST (2011). \"Translational research on irreversible electroporation: VX2 rabbit head and neck\". In Lee E, Kee S, Gehl J. Clinical Aspects of Electroporation. Berlin: Springer. pp. 231\u2013236. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1-4419-8362-7.<\/i><\/span>\n<\/li>\n<li id=\"cite_note-62\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-62\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Maor, Elad; Ivorra, Antoni; Rubinsky, Boris (2009-01-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2650260\" target=\"_blank\">\"Non thermal irreversible electroporation: novel technology for vascular smooth muscle cells ablation\"<\/a>. <i>PLoS One<\/i>. <b>4<\/b> (3): e4757. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1371%2Fjournal.pone.0004757\" target=\"_blank\">10.1371\/journal.pone.0004757<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1932-6203\" target=\"_blank\">1932-6203<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2650260\" target=\"_blank\">2650260<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19270746\" target=\"_blank\">19270746<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=PLoS+One&rft.atitle=Non+thermal+irreversible+electroporation%3A+novel+technology+for+vascular+smooth+muscle+cells+ablation&rft.volume=4&rft.issue=3&rft.pages=e4757&rft.date=2009-01-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2650260&rft.issn=1932-6203&rft_id=info%3Apmid%2F19270746&rft_id=info%3Adoi%2F10.1371%2Fjournal.pone.0004757&rft.aulast=Maor&rft.aufirst=Elad&rft.au=Ivorra%2C+Antoni&rft.au=Rubinsky%2C+Boris&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2650260&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<div class=\"refbegin\" style=\"\">\n<ul><li><cite class=\"citation book\">Rubinsky B (2009). <i>Irreversible Electroporation (Series in Biomedical Engineering)<\/i>. Berlin: Springer. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-642-05419-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Irreversible+Electroporation+%28Series+in+Biomedical+Engineering%29&rft.place=Berlin&rft.pub=Springer&rft.date=2009&rft.isbn=978-3-642-05419-8&rft.au=Rubinsky+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3AIrreversible+electroporation\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1326\nCached time: 20181217085730\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.840 seconds\nReal time usage: 0.953 seconds\nPreprocessor visited node count: 4131\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 152232\/2097152 bytes\nTemplate argument size: 731\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 186557\/5000000 bytes\nNumber of Wikibase entities loaded: 5\/400\nLua time usage: 0.520\/10.000 seconds\nLua memory usage: 5.98 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 853.699 1 -total\n<\/p>\n<pre>74.32% 634.470 1 Template:Reflist\n50.33% 429.695 52 Template:Cite_journal\n 8.86% 75.632 1 Template:Medical_citations_needed\n 8.51% 72.624 1 Template:Cite_web\n 7.00% 59.739 1 Template:Infobox_medical_intervention\n 6.41% 54.763 1 Template:Infobox\n 6.12% 52.215 1 Template:Ambox\n 5.76% 49.143 3 Template:ISBN\n 2.18% 18.596 3 Template:Catalog_lookup_link\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:40142982-1!canonical and timestamp 20181217085729 and revision id 873167422\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Irreversible_electroporation\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214703\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.022 seconds\nReal time usage: 0.168 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 156.538 1 - wikipedia:Irreversible_electroporation\n100.00% 156.538 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8033-0!*!*!*!*!*!* and timestamp 20181217214703 and revision id 24144\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Irreversible_electroporation\">https:\/\/www.limswiki.org\/index.php\/Irreversible_electroporation<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","94395468e1f4b75d1b8f25455b04879e_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e3\/Rod_of_Asclepius2.svg\/25px-Rod_of_Asclepius2.svg.png"],"94395468e1f4b75d1b8f25455b04879e_timestamp":1545083223,"3748414858d7d69051899d8143a4c1e7_type":"article","3748414858d7d69051899d8143a4c1e7_title":"Image-guided surgery","3748414858d7d69051899d8143a4c1e7_url":"https:\/\/www.limswiki.org\/index.php\/Image-guided_surgery","3748414858d7d69051899d8143a4c1e7_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tImage-guided surgery\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tImage-guided surgery (IGS) is any surgical procedure where the surgeon uses tracked surgical instruments in conjunction with preoperative or intraoperative images in order to directly or indirectly guide the procedure. Image guided surgery systems use cameras,ultrasonic, electromagnetic or a combination or fields to capture and relay the patient's anatomy and the surgeon's precise movements in relation to the patient, to computer monitors in the operating room. This is generally performed in real-time though there may be delays of seconds or minutes depending on the modality and application. \nImage-guided surgery helps surgeons perform safer and less invasive procedures and has become a recognized standard of care in managing disorders including cranial, otorhinolaryngology, spine, orthopedic, and cardiovascular.[1] \n\nContents \n\n1 Benefits \n2 Applications \n3 See also \n4 References \n5 Further reading \n\n\nBenefits \nThe benefits of Image-guided surgery include greater control of the surgical procedure, real-time feedback on the effect of the intervention, reduced tissue trauma and disruption in gaining access to the anatomical structure. Image-guided surgery allows for: reduced post-operative neural deficits and adverse events associated with endovenous laser ablative procedures[2], and more effective removal of brain tumors that were once considered inoperable due to their size or location.[3]\n\nApplications \nThe various applications of navigation for neurosurgery have been widely used and reported for almost two decades.[3] According to a study in 2000, researchers were already anticipating that a significant portion of neurosurgery would be performed using computer-based interventions.[4] Recent advancements in ultrasound, including intravascular ultrasound (IVUS) allow for real-time cross sectional mapping of vessels and lateral tissues providing calibrated measurements of vessel diameters, contours and morphology.\nPart of the wider field of computer-assisted surgery, image-guided surgery can take place in hybrid operating rooms using intraoperative imaging. A hybrid operating room is a surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, CT scanners or MRI scanners. Most image-guided surgical procedures are minimally invasive. A field of medicine that pioneered and specializes in minimally invasive image-guided surgery is interventional radiology.\nImage-guided surgery was originally developed for treatment of brain tumors using stereotactic surgery and radiosurgery that are guided by computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) using a technology known as the N-localizer.[5][6][7]\nA hand-held surgical probe is an essential component of any image-guided surgery system as it provides the surgeon with a map of the designated area.[8] During the surgical procedure, the IGS tracks the probe position and displays the anatomy beneath it as, for example, three orthogonal image slices on a workstation-based 3D imaging system. Existing IGS systems use different tracking techniques including mechanical, optical, ultrasonic, and electromagnetic. \nWhen fluorescence modality is adopted to such devices, the technique is also called fluorescence image-guided surgery.\nImage-guided surgery using medical ultrasound utilises sounds waves and as such does not require the protection and safety precautions necessary with ionising radiation modalities such as fluoroscopy, CT, X-Ray and tomography.\n\nSee also \nComputer assisted surgery\nInterventional radiology\nIntraoperative MRI\nRadiosurgery\nStereotactic surgery\nReferences \n\n\n^ \"Surgery and Treatment - Dedicated Computing\". Dedicated Computing. Retrieved 2018-03-14 . \n\n^ \"Dr Joseph Grace et al - Neural Defecits Post Ultrasound Guided Endovenous Laser Ablation Union International de Phlebology World Congress 2018 Melbourne Australia\". docs.google.com. Retrieved 2018-03-03 . \n\n^ a b Mezger U, Jendrewski C, Bartels M (2013). \"Navigation in surgery\". Langenbecks Arch Surg. 398: 501\u201314. doi:10.1007\/s00423-013-1059-4. PMC 3627858 . PMID 23430289. \n\n^ Kelly PJ (Jan 2000). \"What is past is prologue\". Neurosurgery. 46 (1): 16\u201327. doi:10.1093\/neurosurgery\/46.1.16. \n\n^ Galloway, RL Jr. (2015). \"Introduction and Historical Perspectives on Image-Guided Surgery\". In Golby, AJ. Image-Guided Neurosurgery. Amsterdam: Elsevier. pp. 3\u20134. \n\n^ Tse, VCK; Kalani, MYS; Adler, JR (2015). \"Techniques of Stereotactic Localization\". In Chin, LS; Regine, WF. Principles and Practice of Stereotactic Radiosurgery. New York: Springer. p. 28. \n\n^ Saleh, H; Kassas, B (2015). \"Developing Stereotactic Frames for Cranial Treatment\". In Benedict, SH; Schlesinger, DJ; Goetsch, SJ; Kavanagh, BD. Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy. Boca Raton: CRC Press. pp. 156\u2013159. \n\n^ \"Image-Guided Surgery\". care.american-rhinologic.org. Retrieved 2018-03-14 . \n\n\nFurther reading \nKhan, FR; Henderson, JM (2013). \"Deep Brain Stimulation Surgical Techniques\". In Lozano, AM; Hallet, M. Brain Stimulation: Handbook of Clinical Neurology. 116. Amsterdam: Elsevier. pp. 28\u201330. \nArle, J (2009). \"Development of a Classic: the Todd-Wells Apparatus, the BRW, and the CRW Stereotactic Frames\". In Lozano, AM; Gildenberg, PL; Tasker, RR. Textbook of Stereotactic and Functional Neurosurgery. Berlin: Springer-Verlag. pp. 456\u2013461. \nBrown RA, Nelson JA (June 2012). \"Invention of the N-localizer for stereotactic neurosurgery and its use in the Brown-Roberts-Wells stereotactic frame\". Neurosurgery. 70 (Operative Supplement 2): 173\u2013176. doi:10.1227\/NEU.0b013e318246a4f7. PMID 22186842. \nBrown RA, Nelson JA (2016). \"The invention and early history of the N-localizer for stereotactic neurosurgery\". Cureus. 8 (6): e642. doi:10.7759\/cureus.642. PMC 4959822 . PMID 27462476. CS1 maint: Uses authors parameter (link) \n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Image-guided_surgery\">https:\/\/www.limswiki.org\/index.php\/Image-guided_surgery<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 9 March 2016, at 17:18.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 326 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","3748414858d7d69051899d8143a4c1e7_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Image-guided_surgery skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Image-guided surgery<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Image-guided surgery<\/b> (<b>IGS<\/b>) is any <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgical<\/a> procedure where the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgeon\" title=\"Surgeon\" rel=\"external_link\" target=\"_blank\">surgeon<\/a> uses tracked surgical instruments in conjunction with preoperative or intraoperative images in order to directly or indirectly guide the procedure. Image guided surgery systems use cameras,ultrasonic, electromagnetic or a combination or fields to capture and relay the patient's anatomy and the surgeon's precise movements in relation to the patient, to computer monitors in the operating room. This is generally performed in real-time though there may be delays of seconds or minutes depending on the modality and application. \n<\/p><p>Image-guided surgery helps surgeons perform safer and less invasive procedures and has become a recognized standard of care in managing disorders including cranial, otorhinolaryngology, spine, orthopedic, and cardiovascular.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> \n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Benefits\">Benefits<\/span><\/h2>\n<p>The benefits of Image-guided surgery include greater control of the surgical procedure, real-time feedback on the effect of the intervention, reduced tissue trauma and disruption in gaining access to the anatomical structure. Image-guided surgery allows for: reduced post-operative neural deficits and adverse events associated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endovenous_laser_treatment\" title=\"Endovenous laser treatment\" rel=\"external_link\" target=\"_blank\">endovenous laser ablative<\/a> procedures<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>, and more effective removal of brain tumors that were once considered inoperable due to their size or location.<sup id=\"rdp-ebb-cite_ref-auto_3-0\" class=\"reference\"><a href=\"#cite_note-auto-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>The various applications of navigation for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurosurgery\" title=\"Neurosurgery\" rel=\"external_link\" target=\"_blank\">neurosurgery<\/a> have been widely used and reported for almost two decades.<sup id=\"rdp-ebb-cite_ref-auto_3-1\" class=\"reference\"><a href=\"#cite_note-auto-3\" rel=\"external_link\">[3]<\/a><\/sup> According to a study in 2000, researchers were already anticipating that a significant portion of neurosurgery would be performed using computer-based interventions.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Recent advancements in ultrasound, including intravascular ultrasound (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Intravascular_ultrasound\" title=\"Intravascular ultrasound\" rel=\"external_link\" target=\"_blank\">IVUS<\/a>) allow for real-time cross sectional mapping of vessels and lateral tissues providing calibrated measurements of vessel diameters, contours and morphology.\n<\/p><p>Part of the wider field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-assisted_surgery\" title=\"Computer-assisted surgery\" rel=\"external_link\" target=\"_blank\">computer-assisted surgery<\/a>, image-guided surgery can take place in hybrid operating rooms using intraoperative imaging. A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hybrid_operating_room\" title=\"Hybrid operating room\" rel=\"external_link\" target=\"_blank\">hybrid operating room<\/a> is a surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, CT scanners or MRI scanners. Most image-guided surgical procedures are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive\" class=\"mw-redirect\" title=\"Minimally invasive\" rel=\"external_link\" target=\"_blank\">minimally invasive<\/a>. A field of medicine that pioneered and specializes in minimally invasive image-guided surgery is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_radiology\" title=\"Interventional radiology\" rel=\"external_link\" target=\"_blank\">interventional radiology<\/a>.\n<\/p><p>Image-guided surgery was originally developed for treatment of brain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumors\" class=\"mw-redirect\" title=\"Tumors\" rel=\"external_link\" target=\"_blank\">tumors<\/a> using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereotactic_surgery\" title=\"Stereotactic surgery\" rel=\"external_link\" target=\"_blank\">stereotactic surgery<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiosurgery\" title=\"Radiosurgery\" rel=\"external_link\" target=\"_blank\">radiosurgery<\/a> that are guided by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography\" class=\"mw-redirect\" title=\"Computed tomography\" rel=\"external_link\" target=\"_blank\">computed tomography<\/a> (CT), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">magnetic resonance imaging<\/a> (MRI) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Positron_emission_tomography\" title=\"Positron emission tomography\" rel=\"external_link\" target=\"_blank\">positron emission tomography<\/a> (PET) using a technology known as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/N-localizer\" title=\"N-localizer\" rel=\"external_link\" target=\"_blank\">N-localizer<\/a>.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>A hand-held surgical probe is an essential component of any image-guided surgery system as it provides the surgeon with a map of the designated area.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> During the surgical procedure, the IGS tracks the probe position and displays the anatomy beneath it as, for example, three orthogonal image slices on a workstation-based 3D imaging system. Existing IGS systems use different tracking techniques including mechanical, optical, ultrasonic, and electromagnetic. \n<\/p><p>When <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorescence\" title=\"Fluorescence\" rel=\"external_link\" target=\"_blank\">fluorescence<\/a> modality is adopted to such devices, the technique is also called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluorescence_image-guided_surgery\" title=\"Fluorescence image-guided surgery\" rel=\"external_link\" target=\"_blank\">fluorescence image-guided surgery<\/a>.\n<\/p><p>Image-guided surgery using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_ultrasound\" title=\"Medical ultrasound\" rel=\"external_link\" target=\"_blank\">medical ultrasound<\/a> utilises sounds waves and as such does not require the protection and safety precautions necessary with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ionizing_radiation\" title=\"Ionizing radiation\" rel=\"external_link\" target=\"_blank\">ionising radiation<\/a> modalities such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">fluoroscopy<\/a>, CT, X-Ray and tomography.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer_assisted_surgery\" class=\"mw-redirect\" title=\"Computer assisted surgery\" rel=\"external_link\" target=\"_blank\">Computer assisted surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_radiology\" title=\"Interventional radiology\" rel=\"external_link\" target=\"_blank\">Interventional radiology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Intraoperative_MRI\" title=\"Intraoperative MRI\" rel=\"external_link\" target=\"_blank\">Intraoperative MRI<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiosurgery\" title=\"Radiosurgery\" rel=\"external_link\" target=\"_blank\">Radiosurgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Stereotactic_surgery\" title=\"Stereotactic surgery\" rel=\"external_link\" target=\"_blank\">Stereotactic surgery<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.dedicatedcomputing.com\/oem\/markets\/healthcare\/surgery-and-treatment\/\" target=\"_blank\">\"Surgery and Treatment - Dedicated Computing\"<\/a>. <i>Dedicated Computing<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-03-14<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Dedicated+Computing&rft.atitle=Surgery+and+Treatment+-+Dedicated+Computing&rft_id=https%3A%2F%2Fwww.dedicatedcomputing.com%2Foem%2Fmarkets%2Fhealthcare%2Fsurgery-and-treatment%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/docs.google.com\/document\/d\/e\/2PACX-1vQnU5wYkr4eqtjFatBkgD0GjM7PbfTmhX2LC9fhKqji0SWYgX0m3W_jnL2P7WPF3uRh4OjkXEuv0Lo7\/pub\" target=\"_blank\">\"Dr Joseph Grace et al - Neural Defecits Post Ultrasound Guided Endovenous Laser Ablation Union International de Phlebology World Congress 2018 Melbourne Australia\"<\/a>. <i>docs.google.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-03-03<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=docs.google.com&rft.atitle=Dr+Joseph+Grace+et+al+-+Neural+Defecits+Post+Ultrasound+Guided+Endovenous+Laser+Ablation+Union+International+de+Phlebology+World+Congress+2018+Melbourne+Australia&rft_id=https%3A%2F%2Fdocs.google.com%2Fdocument%2Fd%2Fe%2F2PACX-1vQnU5wYkr4eqtjFatBkgD0GjM7PbfTmhX2LC9fhKqji0SWYgX0m3W_jnL2P7WPF3uRh4OjkXEuv0Lo7%2Fpub&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-auto-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-auto_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-auto_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mezger U, Jendrewski C, Bartels M (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3627858\" target=\"_blank\">\"Navigation in surgery\"<\/a>. <i>Langenbecks Arch Surg<\/i>. <b>398<\/b>: 501\u201314. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs00423-013-1059-4\" target=\"_blank\">10.1007\/s00423-013-1059-4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3627858\" target=\"_blank\">3627858<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23430289\" target=\"_blank\">23430289<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Langenbecks+Arch+Surg&rft.atitle=Navigation+in+surgery&rft.volume=398&rft.pages=501-14&rft.date=2013&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3627858&rft_id=info%3Apmid%2F23430289&rft_id=info%3Adoi%2F10.1007%2Fs00423-013-1059-4&rft.aulast=Mezger&rft.aufirst=U&rft.au=Jendrewski%2C+C&rft.au=Bartels%2C+M&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3627858&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kelly PJ (Jan 2000). \"What is past is prologue\". <i>Neurosurgery<\/i>. <b>46<\/b> (1): 16\u201327. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1093%2Fneurosurgery%2F46.1.16\" target=\"_blank\">10.1093\/neurosurgery\/46.1.16<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurosurgery&rft.atitle=What+is+past+is+prologue&rft.volume=46&rft.issue=1&rft.pages=16-27&rft.date=2000-01&rft_id=info%3Adoi%2F10.1093%2Fneurosurgery%2F46.1.16&rft.au=Kelly+PJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Galloway, RL Jr. (2015). \"Introduction and Historical Perspectives on Image-Guided Surgery\". In Golby, AJ. <i>Image-Guided Neurosurgery<\/i>. Amsterdam: Elsevier. pp. 3\u20134.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Introduction+and+Historical+Perspectives+on+Image-Guided+Surgery&rft.btitle=Image-Guided+Neurosurgery&rft.place=Amsterdam&rft.pages=3-4&rft.pub=Elsevier&rft.date=2015&rft.aulast=Galloway&rft.aufirst=RL+Jr.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Tse, VCK; Kalani, MYS; Adler, JR (2015). \"Techniques of Stereotactic Localization\". In Chin, LS; Regine, WF. <i>Principles and Practice of Stereotactic Radiosurgery<\/i>. New York: Springer. p. 28.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Techniques+of+Stereotactic+Localization&rft.btitle=Principles+and+Practice+of+Stereotactic+Radiosurgery&rft.place=New+York&rft.pages=28&rft.pub=Springer&rft.date=2015&rft.aulast=Tse&rft.aufirst=VCK&rft.au=Kalani%2C+MYS&rft.au=Adler%2C+JR&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Saleh, H; Kassas, B (2015). \"Developing Stereotactic Frames for Cranial Treatment\". In Benedict, SH; Schlesinger, DJ; Goetsch, SJ; Kavanagh, BD. <i>Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy<\/i>. Boca Raton: CRC Press. pp. 156\u2013159.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Developing+Stereotactic+Frames+for+Cranial+Treatment&rft.btitle=Stereotactic+Radiosurgery+and+Stereotactic+Body+Radiation+Therapy&rft.place=Boca+Raton&rft.pages=156-159&rft.pub=CRC+Press&rft.date=2015&rft.aulast=Saleh&rft.aufirst=H&rft.au=Kassas%2C+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/care.american-rhinologic.org\/igs\" target=\"_blank\">\"Image-Guided Surgery\"<\/a>. <i>care.american-rhinologic.org<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-03-14<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=care.american-rhinologic.org&rft.atitle=Image-Guided+Surgery&rft_id=http%3A%2F%2Fcare.american-rhinologic.org%2Figs&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite class=\"citation book\">Khan, FR; Henderson, JM (2013). \"Deep Brain Stimulation Surgical Techniques\". In Lozano, AM; Hallet, M. <i>Brain Stimulation: Handbook of Clinical Neurology<\/i>. <b>116<\/b>. Amsterdam: Elsevier. pp. 28\u201330.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Deep+Brain+Stimulation+Surgical+Techniques&rft.btitle=Brain+Stimulation%3A+Handbook+of+Clinical+Neurology&rft.place=Amsterdam&rft.pages=28-30&rft.pub=Elsevier&rft.date=2013&rft.aulast=Khan&rft.aufirst=FR&rft.au=Henderson%2C+JM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation book\">Arle, J (2009). \"Development of a Classic: the Todd-Wells Apparatus, the BRW, and the CRW Stereotactic Frames\". In Lozano, AM; Gildenberg, PL; Tasker, RR. <i>Textbook of Stereotactic and Functional Neurosurgery<\/i>. Berlin: Springer-Verlag. pp. 456\u2013461.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Development+of+a+Classic%3A+the+Todd-Wells+Apparatus%2C+the+BRW%2C+and+the+CRW+Stereotactic+Frames&rft.btitle=Textbook+of+Stereotactic+and+Functional+Neurosurgery&rft.place=Berlin&rft.pages=456-461&rft.pub=Springer-Verlag&rft.date=2009&rft.aulast=Arle&rft.aufirst=J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Brown RA, Nelson JA (June 2012). \"Invention of the N-localizer for stereotactic neurosurgery and its use in the Brown-Roberts-Wells stereotactic frame\". <i>Neurosurgery<\/i>. <b>70<\/b> (Operative Supplement 2): 173\u2013176. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1227%2FNEU.0b013e318246a4f7\" target=\"_blank\">10.1227\/NEU.0b013e318246a4f7<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22186842\" target=\"_blank\">22186842<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurosurgery&rft.atitle=Invention+of+the+N-localizer+for+stereotactic+neurosurgery+and+its+use+in+the+Brown-Roberts-Wells+stereotactic+frame&rft.volume=70&rft.issue=Operative+Supplement+2&rft.pages=173-176&rft.date=2012-06&rft_id=info%3Adoi%2F10.1227%2FNEU.0b013e318246a4f7&rft_id=info%3Apmid%2F22186842&rft.aulast=Brown&rft.aufirst=RA&rft.au=Nelson%2C+JA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Brown RA, Nelson JA (2016). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4959822\" target=\"_blank\">\"The invention and early history of the N-localizer for stereotactic neurosurgery\"<\/a>. <i>Cureus<\/i>. <b>8<\/b> (6): e642. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.7759%2Fcureus.642\" target=\"_blank\">10.7759\/cureus.642<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4959822\" target=\"_blank\">4959822<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27462476\" target=\"_blank\">27462476<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cureus&rft.atitle=The+invention+and+early+history+of+the+N-localizer+for+stereotactic+neurosurgery&rft.volume=8&rft.issue=6&rft.pages=e642&rft.date=2016&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4959822&rft_id=info%3Apmid%2F27462476&rft_id=info%3Adoi%2F10.7759%2Fcureus.642&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4959822&rfr_id=info%3Asid%2Fen.wikipedia.org%3AImage-guided+surgery\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Uses authors parameter (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Uses_authors_parameter\" title=\"Category:CS1 maint: Uses authors parameter\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1331\nCached time: 20181127134715\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.172 seconds\nReal time usage: 0.204 seconds\nPreprocessor visited node count: 577\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 20670\/2097152 bytes\nTemplate argument size: 84\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 27544\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.115\/10.000 seconds\nLua memory usage: 3.31 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 176.287 1 -total\n<\/p>\n<pre>87.46% 154.175 1 Template:Reflist\n39.61% 69.835 1 Template:Cite_news\n28.51% 50.259 4 Template:Cite_journal\n15.35% 27.059 5 Template:Cite_book\n 5.25% 9.258 2 Template:Cite_web\n 1.49% 2.625 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1455545-1!canonical and timestamp 20181127134715 and revision id 851647294\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Image-guided_surgery\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214703\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.170 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 163.508 1 - wikipedia:Image-guided_surgery\n100.00% 163.508 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8304-0!*!*!*!*!*!* and timestamp 20181217214702 and revision id 24517\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Image-guided_surgery\">https:\/\/www.limswiki.org\/index.php\/Image-guided_surgery<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","3748414858d7d69051899d8143a4c1e7_images":[],"3748414858d7d69051899d8143a4c1e7_timestamp":1545083222,"18026209e7901858227ab2cae8f033cf_type":"article","18026209e7901858227ab2cae8f033cf_title":"Hip replacement","18026209e7901858227ab2cae8f033cf_url":"https:\/\/www.limswiki.org\/index.php\/Hip_replacement","18026209e7901858227ab2cae8f033cf_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tHip replacement\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is about human hip replacement. For hip replacement in animals, see Hip replacement (animal).\nHip replacementAn X-ray showing a right hip (left of image) has been replaced, with the ball of this ball-and-socket joint replaced by a metal head that is set in the femur and the socket replaced by a white plastic cup (clear in this X-ray).ICD-9-CM81.51\u201381.53MeSHD019644 MedlinePlus002975 [edit on Wikidata]\nHip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures. A total hip replacement (total hip arthroplasty) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is currently one of the most common orthopaedic operations, though patient satisfaction short- and long-term varies widely. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.[1]\n\nContents \n\n1 Medical uses \n2 Modern process \n3 Techniques \n\n3.1 Posterior approach \n3.2 Lateral approach \n3.3 Antero-lateral approach \n3.4 Anterior approach \n3.5 Minimally invasive approaches \n\n\n4 Implants \n\n4.1 Acetabular cup \n4.2 Femoral component \n4.3 Articular interface \n\n\n5 Configuration \n6 Risks \n\n6.1 Infection \n6.2 Dislocation \n6.3 Limb Length Inequality \n6.4 Fracture \n6.5 Vein thrombosis \n6.6 Osteolysis \n6.7 Loosening \n6.8 Metal sensitivity \n6.9 Metal toxicity \n6.10 Nerve palsy \n6.11 Chronic pain \n6.12 Death \n6.13 Metal-on-metal hip implant failure \n\n\n7 Alternatives and variations \n\n7.1 Conservative management \n7.2 Preoperative care \n7.3 Hemiarthroplasty \n7.4 Hip resurfacing \n7.5 Viscosupplementation \n\n\n8 Prevalence and cost \n9 History \n10 See also \n11 References \n12 External links \n\n\nMedical uses \nTotal hip replacement is most commonly used to treat joint failure caused by osteoarthritis. Other indications include rheumatoid arthritis, avascular necrosis, traumatic arthritis, protrusio acetabuli, certain hip fractures, benign and malignant bone tumors, arthritis associated with Paget's disease, ankylosing spondylitis and juvenile rheumatoid arthritis. The aims of the procedure are pain relief and improvement in hip function. Hip replacement is usually considered only after other therapies, such as physical therapy and pain medications, have failed.\n\nModern process \n Main components of a hip prosthesis[2]\n A titanium hip prosthesis, with a ceramic head and polyethylene acetabular cup\nThe modern artificial joint owes much to the 1962 work of Sir John Charnley at Wrightington Hospital. His work in the field of tribology resulted in a design that almost completely replaced the other designs by the 1970s. Charnley's design consisted of three parts:\n\nstainless steel one-piece femoral stem and head\npolyethylene (originally Teflon), acetabular component, both of which were fixed to the bone using\nPMMA (acrylic) bone cement\nThe replacement joint, which was known as the Low Friction Arthroplasty, was lubricated with synovial fluid. The small femoral head (7⁄8  in (22.2 mm)) was chosen for Charnley's belief that it would have lower friction against the acetabular component and thus wear out the acetabulum more slowly. Unfortunately, the smaller head dislocated more easily. Alternative designs with larger heads such as the Mueller prosthesis were proposed. Stability was improved, but acetabular wear and subsequent failure rates were increased with these designs. The Teflon acetabular components of Charnley's early designs failed within a year or two of implantation. This prompted a search for a more suitable material. A German salesman showed a polyethylene gear sample to Charnley's machinist, sparking the idea to use this material for the acetabular component. The ultra high molecular weight polyethylene or UHMWPE acetabular component was introduced in 1962. Charnley's other major contribution was to use polymethylmethacrylate (PMMA) bone cement to attach the two components to the bone. For over two decades, the Charnley Low Friction Arthroplasty, and derivative designs were the most used systems in the world. It formed the basis for all modern hip implants.\nThe Exeter hip stem was developed in the United Kingdom during the same time as the Charnley device. Its development occurred following a collaboration between Orthopaedic Surgeon Robin Ling and University of Exeter engineer Clive Lee and it was first implanted at the Princess Elizabeth Orthopaedic Hospital in Exeter in 1970.[3] The Exeter Hip is a cemented device, but with a slightly different stem geometry. Both designs have shown excellent long-term durability when properly placed and are still widely used in slightly modified versions.\nEarly implant designs had the potential to loosen from their attachment to the bones, typically becoming painful ten to twelve years after placement. In addition, erosion of the bone around the implant was seen on x-rays. Initially, surgeons believed this was caused by an abnormal reaction to the cement holding the implant in place. That belief prompted a search for an alternative method to attach the implants. The Austin Moore device had a small hole in the stem into which bone graft was placed before implanting the stem. It was hoped bone would then grow through the window over time and hold the stem in position. Success was unpredictable and the fixation not very robust. In the early 1980s, surgeons in the United States applied a coating of small beads to the Austin Moore device and implanted it without cement. The beads were constructed so that gaps between beads matched the size of the pores in native bone. Over time, bone cells from the patient would grow into these spaces and fix the stem in position. The stem was modified slightly to fit more tightly into the femoral canal, resulting in the Anatomic Medullary Locking (AML) stem design. With time, other forms of stem surface treatment and stem geometry have been developed and improved.\nInitial hip designs were made of a one-piece femoral component and a one-piece acetabular component. Current designs have a femoral stem and separate head piece. Using an independent head allows the surgeon to adjust leg length (some heads seat more or less onto the stem) and to select from various materials from which the head is formed. A modern acetabulum component is also made up of two parts: a metal shell with a coating for bone attachment and a separate liner. First the shell is placed. Its position can be adjusted, unlike the original cemented cup design which are fixed in place once the cement sets. When proper positioning of the metal shell is obtained, the surgeon may select a liner made from various materials.\nTo combat loosening caused by polyethylene wear debris, hip manufacturers developed improved and novel materials for the acetabular liners. Ceramic heads mated with regular polyethylene liners or a ceramic liner were the first significant alternative. Metal liners to mate with a metal head were also developed. At the same time these designs were being developed, the problems that caused polyethylene wear were determined and manufacturing of this material improved. Highly crosslinked UHMWPE was introduced in the late 1990s. The most recent data comparing the various bearing surfaces has shown no clinically significant differences in their performance. Potential early problems with each material are discussed below. Performance data after 20 or 30 years may be needed to demonstrate significant differences in the devices. All newer materials allow use of larger diameter femoral heads. Use of larger heads significantly decreases the chance of the hip dislocating, which remains the greatest complication of the surgery.\nWhen currently available implants are used, cemented stems tend to have a better longevity than uncemented stems. No significant difference is observed in the clinical performance of the various methods of surface treatment of uncemented devices. Uncemented stems are selected for patients with good quality bone that can resist the forces needed to drive the stem in tightly. Cemented devices are typically selected for patients with poor quality bone who are at risk of fracture during stem insertion. Cemented stems are less expensive due to lower manufacturing cost, but require good surgical technique to place them correctly. Uncemented stems can cause pain with activity in up to 20% of patients during the first year after placement as the bone adapts to the device. This is rarely seen with cemented stems.\nOnce an uncommon operation reserved for frail patients with a limited life expectancy, hip replacement is now common, even among active athletes including race car drivers Bobby Labonte and Dale Jarrett, and the 8-time Major-winning American golfer Tom Watson, who shot a 67 in the opening round of the Masters Tournament in the year following his operation.\n\nTechniques \nThere are several incisions, defined by their relation to the gluteus medius. The approaches are posterior (Moore), lateral (Hardinge or Liverpool),[4] antero-lateral (Watson-Jones),[5] anterior (Smith-Petersen)[6] and greater trochanter osteotomy. There is no compelling evidence in the literature for any particular approach, but consensus of professional opinion favours either modified anterolateral (Watson-Jones) or posterior approach.[citation needed ]\n\nPosterior approach \nThe posterior (Moore or Southern) approach accesses the joint and capsule through the back, taking piriformis muscle and the short external rotators of the femur. This approach gives excellent access to the acetabulum and femur and preserves the hip abductors and thus minimizes the risk of abductor dysfunction post operatively. It has the advantage of becoming a more extensile approach if needed. Critics cite a higher dislocation rate, although repair of the capsule, piriformis and the short external rotators along with use of modern large diameter head balls reduces this risk.\n\nLateral approach \nThe lateral approach is also commonly used for hip replacement. The approach requires elevation of the hip abductors (gluteus medius and gluteus minimus) to access the joint. The abductors may be lifted up by osteotomy of the greater trochanter and reapplying it afterwards using wires (as per Charnley),[citation needed ] or may be divided at their tendinous portion, or through the functional tendon (as per Hardinge) and repaired using sutures. Although this approach has a lower dislocation risk than the posterior approach, critics note that occasionally the abductor muscles do not heal back on, leading to pain and weakness which is often very difficult to treat.\n\nAntero-lateral approach \nThe anterolateral approach develops the interval between the tensor fasciae latae and the gluteus medius. The Gluteus medius, gluteus minimus and hip capsule are detached from the anterior (front) for the greater trochanter and femoral neck and then repaired with heavy suture after the replacement of the joint.\n\nAnterior approach \nThe anterior approach uses an interval between the sartorius muscle and tensor fasciae latae. Dr. Joel Matta and Dr. Bert Thomas have adapted this approach, which was commonly used for pelvic fracture repair surgery, for use when performing hip replacement. When used with older hip implant systems that had a small diameter head, dislocation rates were reduced compared to surgery performed through a posterior approach. With modern implant designs, dislocation rates are similar between the anterior and posterior approaches.[7] The anterior approach has been shown in studies to variably improve early functional recovery, with possible complications of femoral component loosening and early revision compared to other approaches[8][9][10][11][12][13]\n\nMinimally invasive approaches \nThe dual incision approach and other minimally invasive surgery seeks to reduce soft tissue damage through reducing the size of the incision. However, component positioning accuracy and visualization of the bone structures can be significantly impaired as the approaches get smaller. This can result in unintended fractures and soft tissue injury. The majority of current orthopedic surgeons use a \"minimally invasive\" approach compared to traditional approaches which were quite large comparatively.\nComputer-assisted surgery and robotic surgery techniques are also available to guide the surgeon to provide enhanced accuracy. Several commercial CAS and robotic systems are available for use worldwide. Improved patient outcomes and reduced complications have not been demonstrated when these systems are used when compared to standard techniques.[14][15]\n\nImplants \n Metal on metal prosthetic hip\n Cement-free implant sixteen days after surgery. Femoral component is cobalt chromium combined with titanium which induces bone growth into the implant. Ceramic head. Acetabular cup coated with bone growth-inducing material and held temporarily in place with a single screw.\nThe prosthetic implant used in hip replacement consists of three parts: the acetabular cup, the femoral component, and the articular interface. Options exist for different people and indications. The evidence for a number of newer devices is not very good, including: ceramic-on-ceramic bearings, modular femoral necks, and uncemented monoblock cups.[16] Correct selection of the prosthesis is important.\n\nAcetabular cup \nThe acetabular cup is the component which is placed into the acetabulum (hip socket). Cartilage and bone are removed from the acetabulum and the acetabular cup is attached using friction or cement. Some acetabular cups are one piece, while others are modular. One-piece (monobloc) shells are either UHMWPE (ultra-high-molecular-weight polyethylene) or metal, they have their articular surface machined on the inside surface of the cup and do not rely on a locking mechanism to hold a liner in place. A monobloc polyethylene cup is cemented in place while a metal cup is held in place by a metal coating on the outside of the cup. Modular cups consist of two pieces, a shell and liner. The shell is made of metal; the outside has a porous coating while the inside contains a locking mechanism designed to accept a liner. Two types of porous coating used to form a friction fit are sintered beads and a foam metal design to mimic the trabeculae of cancellous bone and initial stability is influenced by under-reaming and insertion force.[17] Permanent fixation is achieved as bone grows onto or into the porous coating. Screws can be used to lag the shell to the bone providing even more fixation. Polyethylene liners are placed into the shell and connected by a rim locking mechanism; ceramic and metal liners are attached with a Morse taper.[citation needed ]\n\nFemoral component \nThis section possibly contains original research. Please improve it by verifying the claims made and adding inline citations. Statements consisting only of original research should be removed. (April 2016) (Learn how and when to remove this template message)The femoral component is the component that fits in the femur (thigh bone). Bone is removed and the femur is shaped to accept the femoral stem with attached prosthetic femoral head (ball). There are two types of fixation: cemented and uncemented. Cemented stems use acrylic bone cement to form a mantle between the stem and to the bone. Uncemented stems use friction, shape and surface coatings to stimulate bone to remodel and bond to the implant. Stems are made of multiple materials (titanium, cobalt chromium, stainless steel, and polymer composites) and they can be monolithic or modular. Modular components consist of different head dimensions and\/or modular neck orientations; these attach via a taper similar to a Morse taper. These options allow for variability in leg length, offset and version. Femoral heads are made of metal or ceramic material. Metal heads, made of cobalt chromium for hardness, are machined to size and then polished to reduce wear of the socket liner. Ceramic heads are more smooth than polished metal heads, have a lower coefficient of friction than a cobalt chrome head, and in theory will wear down the socket liner more slowly. As of early 2011, follow-up studies in patients have not demonstrated significant reductions in wear rates between the various types of femoral heads on the market. Ceramic implants are more brittle and may break after being implanted.\nArticular interface \nThis section possibly contains original research. Please improve it by verifying the claims made and adding inline citations. Statements consisting only of original research should be removed. (April 2016) (Learn how and when to remove this template message)The articular interface is not part of either implant, rather it is the area between the acetabular cup and femoral component. The articular interface of the hip is a simple ball and socket joint. Size, material properties and machining tolerances at the articular interface can be selected based on patient demand to optimise implant function and longevity whilst mitigating associated risks. The interface size is measured by the outside diameter of the head or the inside diameter of the socket. Common sizes of femoral heads are 28 mm (1.1 in), 32 mm (1.3 in) and 36 mm (1.4 in). While 22.25 mm (7⁄8  in) was common in the first modern prostheses, now even larger sizes are available from 38 to over 54 mm. Larger-diameter heads lead to increased stability and range of motion whilst lowering the risk of dislocation. At the same time they are also subject to higher stresses such as friction and inertia. Different combinations of materials have different physical properties which can be coupled to reduce the amount of wear debris generated by friction. Typical pairings of materials include metal on polyethylene (MOP), metal on crosslinked polyethylene (MOXP), ceramic on ceramic (COC), ceramic on crosslinked polyethylene (COXP) and metal on metal (MOM). Each combination has different advantages and disadvantages.\nConfiguration \nPost-operative projectional radiography is routinely performed to ensure proper configuration of hip prostheses.\nThe direction of the acetabular cup influences the range of motion of the leg, and also affects the risk of dislocation.[18] For this purpose, the acetabular inclination and the acetabular anteversion are measurements of cup angulation in the coronal plane and the sagittal plane, respectively.\n\n\n\t\t\n\t\t\t\n\t\t\t\nAcetabular inclination.[19] This parameter is calculated on an anteroposterior radiograph as the angle between a line through the lateral and medial margins of the acetabular cup and the transischial line which is tangential to the inferior margins of the ischium bones.[19]\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nAcetabular inclination is normally between 30 and 50\u00b0.[19] A larger angle increases the risk of dislocation.[18]\n\n\t\t\t\n\t\t\n\n\n\t\t\n\t\t\t\n\t\t\t\nAcetabular anteversion.[20] This parameter is calculated on a lateral radiograph as the angle between the transverse plane and a line going through the (anterior and posterior) margins of the acetabular cup.[20]\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nAcetabular anteversion is normally between 5 and 25\u00b0.[18] An anteversion below or above this range increases the risk of dislocation.[18] There is an intra-individual variability in this method because the pelvis may be tilted in various degrees in relation to the transverse plane.[18]\n\n\t\t\t\n\t\t\n\n\n\t\t\n\t\t\t\n\t\t\t\nLeg length discrepancy after hip replacement is calculated as the vertical distance between the middle of the minor trochanters, using the acetabular tear drops[19] or the transischial line[18] as references for the horizontal plane. A discrepancy of up to 1 cm is generally tolerated.[19][18]\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nCenter of rotation: The horizontal center of rotation is calculated as the distance between the acetabular teardrop and the center of the head (or caput) of the prosthesis and\/or the native femoral head on the contralateral side.[19] The vertical center of rotation instead uses the transischial line for reference.[19] The parameter should be equal on both sides.[19]\n\n\t\t\t\n\t\t\n\nRisks \nRisks and complications in hip replacement are similar to those associated with all joint replacements. They can include infection, dislocation, limb length inequality, loosening, impingement, osteolysis, metal sensitivity, nerve palsy, chronic pain and death. Weight loss surgery before a hip replacement does not appear to change outcomes.[21]\n\nInfection \nInfection is one of the most common causes for revision of a total hip replacement, along with loosening and dislocation. The incidence of infection in primary hip replacement is around 1% or less in the United States.[22] Risk factors for infection include obesity, diabetes, smoking, immunosuppressive medications or diseases, and history of infection.\nModern diagnosis of infection around a total knee replacement is based on the Musculoskeletal Infection Society (MSIS) criteria.[23] They are:\n1.There is a sinus tract communicating with the prosthesis; or\n2. A pathogen is isolated by culture from at least two separate tissue or fluid samples obtained from the affected prosthetic joint; \nor\n\n<\/p>Four of the following six criteria exist:\n1.Elevated serum erythrocyte sedimentation rate (ESR>30mm\/hr) and serum C-reactive protein (CRP>10 mg\/L) concentration,\n2.Elevated synovial leukocyte count,\n3.Elevated synovial neutrophil percentage (PMN%),\n4.Presence of purulence in the affected joint,\n5.Isolation of a microorganism in one culture of periprosthetic tissue or fluid, or\n6.Greater than five neutrophils per high-power field in five high-power fields observed from histologic analysis of periprosthetic tissue at \u00d7400 magnification.\nNone of the above laboratory tests has 100% sensitivity or specificity for diagnosing infection. Specificity improves when the tests are performed in patients in whom clinical suspicion exists. ESR and CRP remain good 1st line tests for screening (high sensitivity, low specificity). Aspiration of the joint remains the test with the highest specificity for confirming infection.\n\nDislocation \n Dislocated artificial hip\n Liner wear, particularly when over 2 mm, increases the risk of dislocation.[24] Liner creep, on the other hand, is normal remoulding.[18]\nDislocation is the most common complication of hip replacement surgery. The most common causes vary by the duration since the surgery.\nHip prosthesis dislocation mostly occurs in the first 3 months after insertion, mainly because of incomplete scar formation and relaxed soft tissues.[24] It takes eight to twelve weeks for the soft tissues injured or cut during surgery to heal. During this period, the hip ball can come out of the socket. The chance of this is diminished if less tissue is cut, if the tissue cut is repaired and if large diameter head balls are used.\nDislocations occurring between 3 months and 5 years after insertion usually occur due to malposition of the components, or dysfunction of nearby muscles.[24]\nRisk factors of late dislocation (after 5 years) mainly include:[24]\n\nFemale gender\nYounger age at primary hip arthroplasty\nPrevious subluxation without complete dislocation\nPrevious trauma\nSubstantial weight loss\nRecent onset or progression of dementia or a neurological disorder\nMalposition of the cup\nWear of the liner, particularly when it causes movement of the head of more than 2 mm within the cup compared to its original position\nProsthesis loosening with migration\nSurgeons who perform more of the operations each year tend to have fewer patients dislocate. Doing the surgery from an anterior approach seems to lower dislocation rates when small diameter heads are used, but the benefit has not been shown when compared to modern posterior incisions with the use of larger diameter heads. The use of larger diameter head size does in it self decrease the risk of dislocation, even though this correlation is only found in head sizes up to 28 mm, thereafter no additional decrease in dislocation rate is found.[25] Patients can decrease the risk further by keeping the leg out of certain positions during the first few months after surgery.\n\nLimb Length Inequality \nMost adults prior to a hip replacement have a limb length inequality of 0\u20132 cm which they were born with and which causes no clinical deficits.[26] It is common for patients to feel a limb length inequality after total hip replacement.[27] Sometimes the leg seems long immediately after surgery when in fact both are equal length. An arthritic hip can develop contractures that make the leg behave as if it is short. When these are relieved with replacement surgery and normal motion and function are restored, the body feels that the limb is now longer than it was. This feeling usually subsides by 6 months after surgery as the body adjusts to the new hip joint. The cause of this feeling is variable, and usually related to abductor muscle weakness, pelvic obliquity, and minor lengthening of the hip during surgery (<1 cm) to achieve stability and restore the joint to pre-arthritic mechanics. If the limb length difference remains bothersome to the patient more than 6 months after surgery, a shoe lift can be used. Only in extreme cases is surgery required for correction.\n\nFracture \nBones with internal fixation devices in situ are at risk of periprosthetic fractures at the end of the implant, an area of relative mechanical stress. Post-operative femoral fractures are graded by the Vancouver classification.\n\nVein thrombosis \nVenous thrombosis such as deep vein thrombosis and pulmonary embolism are relatively common following hip replacement surgery. Standard treatment with anticoagulants is for 7\u201310 days; however treatment for more than 21 days may be superior.[28] Research from 2013 has on the other hand suggested that anticoagulants in otherwise healthy patients undergoing a so-called fast track protocol with hospital stays under five days, might only be necessary while in the hospital.[29]\nSome physicians and patients may consider having an ultrasonography for deep vein thrombosis after hip replacement.[30] However, this kind of screening should only be done when indicated because to perform it routinely would be unnecessary health care.[30]\n\nOsteolysis \nMany long-term problems with hip replacements are the result of osteolysis. This is the loss of bone caused by the body's reaction to polyethylene wear debris, fine bits of plastic that come off the cup liner over time. An inflammatory process causes bone resorption that may lead to subsequent loosening of the hip implants and even fractures in the bone around the implants. In an attempt to eliminate the generation of wear particles, ceramic bearing surfaces are being used in the hope that they will have less wear and less osteolysis with better long-term results. Metal cup liners joined with metal heads (metal-on-metal hip arthroplasty) were also developed for similar reasons. In the lab these show excellent wear characteristics and benefit from a different mode of lubrication. At the same time that these two bearing surfaces were being developed, highly cross linked polyethylene plastic liners were also developed. The greater cross linking significantly reduces the amount of plastic wear debris given off over time. The newer ceramic and metal prostheses do not always have the long-term track record of established metal on poly bearings. Ceramic pieces can break leading to catastrophic failure. This occurs in about 2% of the implants placed. They may also cause an audible, high pitched squeaking noise with activity. Metal-on-metal arthroplasty releases metal debris into the body raising concerns about the potential dangers of these accumulating over time. Highly cross linked polyethylene is not as strong as regular polyethylene. These plastic liners can crack or break free of the metal shell that holds them.\n\nLoosening \n Hip prosthesis displaying aseptic loosening (arrows)\n Hip prosthesis zones according to DeLee and Charnley,[31] and Gruen.[32] These are used to describe the location of for example areas of loosening.\nOn radiography, it is normal to see thin radiolucent areas of less than 2 mm around hip prosthesis components, or between a cement mantle and bone. However, these may still indicate loosening of the prosthesis if they are new or changing, and areas greater than 2 mm may be harmless if they are stable.[33] The most important prognostic factors of cemented cups are absence of radiolucent lines in DeLee and Charnley zone I, as well as adequate cement mantle thickness.[34] In the first year after insertion of uncemented femoral stems, it is normal to have mild subsidence (less than 10 mm).[33] The direct anterior approach has been shown to itself be a risk factor for early femoral component loosening.[9][35][8]\n\nMetal sensitivity \nConcerns are being raised about the metal sensitivity and potential dangers of metal particulate debris. New publications[36][37] have demonstrated development of pseudotumors, soft tissue masses containing necrotic tissue, around the hip joint. It appears these masses are more common in women and these patients show a higher level of iron in the blood. The cause is unknown and is probably multifactorial. There may be a toxic reaction to an excess of particulate metal wear debris or a hypersensitivity reaction to a normal amount of metal debris.\nMetal hypersensitivity is a well-established phenomenon and is common, affecting about 10\u201315% of the population.[38] Contact with metals can cause immune reactions such as skin hives, eczema, redness and itching. Although little is known about the short- and long-term pharmacodynamics and bioavailability of circulating metal degradation products in vivo, there have been many reports of immunologic type responses temporally associated with implantation of metal components. Individual case reports link hypersensitivity immune reactions with adverse performance of metallic clinical cardiovascular, orthopedic and plastic surgical and dental implants.[38]\n\nMetal toxicity \nMain article: Metallosis\nMost hip replacements consist of cobalt and chromium alloys, or titanium. Stainless steel is no longer used. All implants release their constituent ions into the blood. Typically these are excreted in the urine, but in certain individuals the ions can accumulate in the body. In implants which involve metal-on-metal contact, microscopic fragments of cobalt and chromium can be absorbed into the patient's bloodstream. There are reports of cobalt toxicity with hip replacement patients.[39][40]\n\nNerve palsy \nPost operative sciatic nerve palsy is another possible complication. The incidence of this complication is low. Femoral nerve palsy is another but much more rare complication. Both of these will typically resolve over time, but the healing process is slow. Patients with pre-existing nerve injury are at greater risk of experiencing this complication and are also slower to recover.\n\nChronic pain \nA few patients who have had a hip replacement suffer chronic pain after the surgery. Groin pain can develop if the muscle that raises the hip (iliopsoas) rubs against the edge of the acetabular cup. Bursitis can develop at the trochanter where a surgical scar crosses the bone, or if the femoral component used pushes the leg out to the side too far. Also some patients can experience pain in cold or damp weather.[citation needed ] Incision made in the front of the hip (anterior approach) can cut a nerve running down the thigh leading to numbness in the thigh and occasionally chronic pain at the point where the nerve was cut (a neuroma).\n\nDeath \nThe rate of death for elective hip replacements is significantly less than 1%.[41][42]\n\nMetal-on-metal hip implant failure \nSee also: Implant failure\nBy 2010, reports in the orthopaedic literature increasingly cited the problem of early failure of metal on metal prostheses in a small percentage of patients.[43] Failures may relate to release of minute metallic particles or metal ions from wear of the implants, causing pain and disability severe enough to require revision surgery in 1\u20133% of patients.[44] Design deficits of some prothesis models, especially with heat-treated alloys and a lack of special surgical experience accounting for most of the failures. In 2010, surgeons at medical centers such as the Mayo Clinic reported reducing their use of metal-on-metal implants by 80 percent over the previous year in favor of those made from other materials, like combinations of metal and plastic.[45] The cause of these failures remain controversial, and may include both design factors, technique factors, and factors related to patient immune responses (allergy type reactions). In the United Kingdom the Medicines and Healthcare Products Regulatory Agency commenced an annual monitoring regime for metal-on-metal hip replacement patients from May 2010.[46] Data which are shown in The Australian Orthopaedic Association's 2008 National Joint replacement registry, a record of nearly every hip implanted in that country over the previous 10 years, tracked 6,773 BHR (Birmingham Hip Resurfacing) Hips and found that less than one-third of one percent may have been revised due to the patient's reaction to the metal component.[47] Other similar metal-on-metal designs have not fared as well, where some reports show 76% to 100% of the people with these metal-on-metal implants and have aseptic implant failures requiring revision also have evidence of histological inflammation accompanied by extensive lymphocyte infiltrates, characteristic of delayed type hypersensitivity responses.[48] It is not clear to what extent this phenomenon negatively affects orthopedic patients. However, for patients presenting with signs of an allergic reactions, evaluation for sensitivity should be conducted. Removal of the device that is not needed should be considered, since removal may alleviate the symptoms. Patients who have allergic reactions to cheap jewelry are more likely to have reactions to orthopedic implants. There is increasing awareness of the phenomenon of metal sensitivity and many surgeons now take this into account when planning which implant is optimal for each patient.\nOn March 12, 2012, The Lancet published a study, based on data from the National Joint Registry of England and Wales, finding that metal-on-metal hip implants failed at much greater rates than other types of hip implants and calling for a ban on all metal-on-metal hips.[49] The analysis of 402,051 hip replacements showed that 6.2% of metal-on-metal hip implants had failed within five years, compared to 1.7% of metal-on-plastic and 2.3% of ceramic-on-ceramic hip implants. Each 1 mm (0.039 in) increase in head size of metal-on-metal hip implants was associated with a 2% increase of failure.[50] Surgeons of the British Hip Society are recommending that large head metal-on-metal implants should no longer be performed.[51][52]\nOn February 10, 2011, the U.S. FDA issued an advisory on metal-metal hip implants, stating it was continuing to gather and review all available information about metal-on-metal hip systems.[53] On June 27\u201328, 2012, an advisory panel met to decide whether to impose new standards, taking into account findings of the study in The Lancet.[40][54][55] No new standards, such as routine checking of blood metal ion levels, were set, but guidance was updated.[56] Currently, FDA has not required hip implants to be tested in clinical trials before they can be sold in the U.S.[57] Instead, companies making new hip implants only need to prove that they are \"substantially equivalent\" to other hip implants already on the market. The exception is metal-on-metal implants, which were not tested in clinical trials but because of the high revision rate of metal-on-metal hips, in the future the FDA has stated that clinical trials will be required for approval and that post-market studies will be required to keep metal on metal hip implants on the market.[58]\n\nAlternatives and variations \nConservative management \nThe first line approach as an alternative to hip replacement is conservative management which involves a multimodal approach of oral medication, injections, activity modification and physical therapy.[59] Conservative management can prevent or delay the need for hip replacement.\n\nPreoperative care \nPreoperative education is currently an important part of patient care. There is some evidence that it may slightly reduce anxiety before hip or knee replacement, with low risk of negative effects.[60]\n\nHemiarthroplasty \nHemiarthroplasty is a surgical procedure which replaces one half of the joint with an artificial surface and leaves the other part in its natural (pre-operative) state. This class of procedure is most commonly performed on the hip after a subcapital (just below the head) fracture of the neck of the femur (a hip fracture). The procedure is performed by removing the head of the femur and replacing it with a metal or composite prosthesis. The most commonly used prosthesis designs are the Austin Moore prosthesis and the Thompson Prosthesis. More recently a composite of metal and HDPE which forms two interphases (bipolar prosthesis) has also been used. The monopolar prosthesis has not been shown to have any advantage over bipolar designs. The procedure is recommended only for elderly and frail patients, due to their lower life expectancy and activity level. This is because with the passage of time the prosthesis tends to loosen or to erode the acetabulum.[61]\n\n\n\t\t\n\t\t\t\n\t\t\t\nHip prosthesis for hemiarthroplasty. This example is bipolar, meaning that the head has 2 separate articulations.\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nX-ray of the hips, with a right-sided hemiarthroplasty.\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nFemoral (neck) offset is defined as the perpendicular distance between the intramedullary or longitudinal axis of the femur and the center of rotation of the native or prosthetic femoral head. An unnatural offset is associated with hip dislocation.[62]\n\n\t\t\t\n\t\t\n\nHip resurfacing \nHip resurfacing is an alternative to hip replacement surgery. It has been used in Europe for over seventeen years and become a common procedure. Health-related quality of life measures are markedly improved and patient satisfaction is favorable after hip resurfacing arthroplasty.[63]\nThe minimally invasive hip resurfacing procedure is a further refinement to hip resurfacing.\n\nViscosupplementation \nCurrent alternatives also include viscosupplementation, or the injection of artificial lubricants into the joint.[64] Use of these medications in the hip is off label. The cost of treatment is typically not covered by health insurance organizations.\nSome believe that the future of osteoarthritis treatment is bioengineering, targeting the growth and\/or repair of the damaged, arthritic joint. Centeno et al. have reported on the partial regeneration of an arthritic human hip joint using mesenchymal stem cells in one patient.[65] It is yet to be shown that this result will apply to a larger group of patients and result in significant benefits. The FDA has stated that this procedure is being practiced without conforming to regulations, but Centeno claims that it is exempt from FDA regulation. It has not been shown in controlled clinical trials to be effective[citation needed ], and costs over $7,000.\n\nPrevalence and cost \nTotal hip replacement incidence varies in developed countries between 30 (Romania) and 290 (Germany) procedures per 100,000 population per year.[66] Approximately 0.8% of Americans have undergone the procedure.[67]\nAccording to the International Federation of Healthcare Plans, the average cost of a total hip replacement in 2012 was $40,364 in the United States, $11,889 in the United Kingdom, $10,987 in France, $9,574 in Switzerland, and $7,731 in Spain.[1] In the United States, the average cost of a total hip replacement varies widely by geographic region, ranging from $11,327 (Birmingham, Alabama) to $73,927 (Boston, Massachusetts).[68]\n\nHistory \nThe earliest recorded attempts at hip replacement were carried out in Germany in 1891 by Themistocles Gluck (1853\u20131942),[69][70] who used ivory to replace the femoral head (the ball on the femur), attaching it with nickel-plated screws, Plaster of Paris, and glue.[71]\nOn September 28, 1940 at Columbia Hospital in Columbia, South Carolina, American surgeon Dr. Austin T. Moore (1899\u20131963)[72] performed the first metallic hip replacement surgery. The original prosthesis he designed was a proximal femoral replacement, with a large fixed head made of the cobalt-chrome alloy Vitallium. It was about a foot in length and bolted to the resected end of the femoral shaft (hemiarthroplasty). A later version, the so-called Austin Moore Prosthesis which was introduced in 1952, is still in use today, although rarely. Like modern hip implants, it is inserted into the medullary canal of the femur, and depends on bone growth through a hole in the stem for long-term attachment.\n\nSee also \nAbductor wedge\nFemoral Acetabular Impingement\nGruen zone\nHip examination\n2010 DePuy Hip Recall\nReferences \n\n\n^ a b \"2012 comparative price report\" (PDF) . International Federation of Health Plans. Retrieved 4 October 2015 . \n\n^ Andrew Still (2002-11-02). \"Total Hip Replacement\". University of Southern California. Retrieved 2017-01-05 . \n\n^ Timperley, A John (20 October 2017). \"Robin Ling obituary\". The Guardian. Retrieved 22 October 2017 . \n\n^ Pai VS (1997). \"A comparison of three lateral approaches in primary total hip replacement\". Int Orthop. 21 (6): 393\u2013398. doi:10.1007\/s002640050193. PMC 3619565 . PMID 9498150. Archived from the original on 2002-01-08. \n\n^ \"Anterolateral Approach to Hip Joint: (Watson Jones) \u2013 Wheeless' Textbook of Orthopaedics\". Retrieved 2007-11-26 . \n\n^ \"Anterior Approach to the Hip (Smith Petersen) \u2013 Wheeless' Textbook of Orthopaedics\". Retrieved 2007-11-26 . \n\n^ Maratt, Joseph D.; Gagnier, Joel J.; Butler, Paul D.; Hallstrom, Brian R.; Urquhart, Andrew G.; Roberts, Karl C. (September 2016). \"No Difference in Dislocation Seen in Anterior Vs Posterior Approach Total Hip Arthroplasty\". The Journal of Arthroplasty. 31 (9): 127\u2013130. doi:10.1016\/j.arth.2016.02.071. \n\n^ a b Meneghini, R. Michael; Elston, Addison S.; Chen, Antonia F.; Kheir, Michael M.; Fehring, Thomas K.; Springer, Bryan D. (January 2017). \"Direct Anterior Approach\". The Journal of Bone and Joint Surgery. 99 (2): 99\u2013105. doi:10.2106\/JBJS.16.00060. PMID 28099299. \n\n^ a b Eto, Shuichi; Hwang, Katherine; Huddleston, James I.; Amanatullah, Derek F.; Maloney, William J.; Goodman, Stuart B. (March 2017). \"The Direct Anterior Approach is Associated With Early Revision Total Hip Arthroplasty\". The Journal of Arthroplasty. 32 (3): 1001\u20131005. doi:10.1016\/j.arth.2016.09.012. PMID 27843039. \n\n^ Christensen, Christian P.; Jacobs, Cale A. (September 2015). \"Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study\". The Journal of Arthroplasty. 30 (9): 94\u201397. doi:10.1016\/j.arth.2014.12.038. \n\n^ Higgins, Brendan T.; Barlow, Daniel R.; Heagerty, Nathan E.; Lin, Tim J. (March 2015). \"Anterior vs. Posterior Approach for Total Hip Arthroplasty, a Systematic Review and Meta-analysis\". The Journal of Arthroplasty. 30 (3): 419\u2013434. doi:10.1016\/j.arth.2014.10.020. \n\n^ Meermans, G.; Konan, S.; Das, R.; Volpin, A.; Haddad, F. S. (June 2017). \"The direct anterior approach in total hip arthroplasty\". The Bone & Joint Journal. 99-B (6): 732\u2013740. doi:10.1302\/0301-620X.99B6.38053. \n\n^ Graves, Sara C.; Dropkin, Benjamin M.; Keeney, Benjamin J.; Lurie, Jon D.; Tomek, Ivan M. (30 November 2015). \"Does Surgical Approach Affect Patient-reported Function After Primary THA?\". Clinical Orthopaedics and Related Research. 474 (4): 971\u2013981. doi:10.1007\/s11999-015-4639-5. PMC 4773324 . \n\n^ Parsley, Brian S. (February 2018). \"Robotics in Orthopedics: A Brave New World\". The Journal of Arthroplasty. doi:10.1016\/j.arth.2018.02.032. \n\n^ Jacofsky, David J.; Allen, Mark (October 2016). \"Robotics in Arthroplasty: A Comprehensive Review\". The Journal of Arthroplasty. 31 (10): 2353\u20132363. doi:10.1016\/j.arth.2016.05.026. \n\n^ Nieuwenhuijse, M. J.; Nelissen, R. G. H. H.; Schoones, J. W.; Sedrakyan, A. (9 September 2014). \"Appraisal of evidence base for introduction of new implants in hip and knee replacement: a systematic review of five widely used device technologies\". BMJ. 349 (sep09 1): g5133\u2013g5133. doi:10.1136\/bmj.g5133. \n\n^ Amirouche, Farid (2014). \"Factors influencing initial cup stability in total hip arthroplasty\". Clinical Biomechanics. 29 (10): 1177\u201385. doi:10.1016\/j.clinbiomech.2014.09.006. PMID 25266242. \n\n^ a b c d e f g h Iain Watt, Susanne Boldrik, Evert van Langelaan and Robin Smithuis. \"Hip - Arthroplasty -Normal and abnormal imaging findings\". Radiology Assistant. Retrieved 2017-05-21 . CS1 maint: Multiple names: authors list (link) \n\n^ a b c d e f g h Vanrusselt, Jan; Vansevenant, Milan; Vanderschueren, Geert; Vanhoenacker, Filip (2015). \"Postoperative radiograph of the hip arthroplasty: what the radiologist should know\". Insights into Imaging. 6 (6): 591\u2013600. doi:10.1007\/s13244-015-0438-5. ISSN 1869-4101. PMID 26487647. \n\n^ a b Shin, W. C.; Lee, S. M.; Lee, K. W.; Cho, H. J.; Lee, J. S.; Suh, K. T. (2015). \"The reliability and accuracy of measuring anteversion of the acetabular component on plain anteroposterior and lateral radiographs after total hip arthroplasty\". The Bone & Joint Journal. 97-B (5): 611\u2013616. doi:10.1302\/0301-620X.97B5.34735. ISSN 2049-4394. \n\n^ Smith, TO; Aboelmagd, T; Hing, CB; MacGregor, A (September 2016). \"Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients? Systematic review and meta-analysis\". The Bone & Joint Journal. 98-B (9): 1160\u20131166. doi:10.1302\/0301-620x.98b9.38024. PMID 27587514. \n\n^ Bozic, Kevin J; Kurtz, Steven M; Lau, Edmund; Ong, Kevin; Vail, Thomas P; Berry, Daniel J (January 2009). \"The Epidemiology of Revision Total Hip Arthroplasty in the United States\". The Journal of Bone and Joint Surgery. American Volume. 91 (1): 128\u2013133. doi:10.2106\/JBJS.H.00155. \n\n^ Parvizi, Javad; Zmistowski, Benjamin; Berbari, Elie F.; Bauer, Thomas W.; Springer, Bryan D.; Della Valle, Craig J.; Garvin, Kevin L.; Mont, Michael A.; Wongworawat, Montri D.; Zalavras, Charalampos G. (22 September 2011). \"New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society\". Clinical Orthopaedics and Related Research. 469 (11): 2992\u20132994. doi:10.1007\/s11999-011-2102-9. PMC 3183178 . \n\n^ a b c d Daniel J. Berry, Jay Lieberman (2012). Surgery of the Hip. Elsevier Health Sciences. p. 1035. ISBN 9781455727056. \n\n^ Hailer, Nils P.; Weiss, R\u00fcdiger J.; Stark, Andr\u00e9; K\u00e4rrholm, Johan (October 2012). \"The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. An analysis of 78,098 operations in the Swedish Hip Arthroplasty Register\". Acta Orthopaedica. 83 (5): 442\u2013448. doi:10.3109\/17453674.2012.733919. ISSN 1745-3682. PMC 3488169 . PMID 23039167. \n\n^ Knutson, Gary A (2005). \"Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance\". Chiropractic & Osteopathy. 13 (1): 11. doi:10.1186\/1746-1340-13-11. PMC 1232860 . \n\n^ Maloney, William J; Keeney, James A (June 2004). \"Leg length discrepancy after total hip arthroplasty\". The Journal of Arthroplasty. 19 (4): 108\u2013110. doi:10.1016\/j.arth.2004.02.018. \n\n^ Sobieraj, DM; Lee, S; Coleman, CI; Tongbram, V; Chen, W; Colby, J; Kluger, J; Makanji, S; Ashaye, AO; White, CM (May 15, 2012). \"Prolonged versus standard-duration venous thromboprophylaxis in major orthopedic surgery: a systematic review\". Annals of Internal Medicine. 156 (10): 720\u20137. doi:10.7326\/0003-4819-156-10-201205150-00423. PMID 22412039. \n\n^ J\u00f8rgensen, Christoffer C.; Jacobsen, Michael K.; Soeballe, Kjeld; Hansen, Torben B.; Husted, Henrik; Kj\u00e6rsgaard-Andersen, Per; Hansen, Lars T.; Laursen, Mogens B.; Kehlet, Henrik (2013). \"Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study\". BMJ Open. 3 (12): e003965. doi:10.1136\/bmjopen-2013-003965. ISSN 2044-6055. PMC 3863129 . PMID 24334158. \n\n^ a b American Academy of Orthopaedic Surgeons (February 2013), \"Five Things Physicians and Patients Should Question\", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Orthopaedic Surgeons, retrieved 19 May 2013 , which cites\nMembers of 2007 and 2011 AAOS Guideline Development Work Groups on PE\/VTED Prophylaxis; Mont, M; Jacobs, J; Lieberman, J; Parvizi, J; Lachiewicz, P; Johanson, N; Watters, W (Apr 18, 2012). \"Preventing venous thromboembolic disease in patients undergoing elective total hip and knee arthroplasty\". The Journal of Bone and Joint Surgery. American Volume. 94 (8): 673\u20134. doi:10.2106\/JBJS.9408edit. PMC 3326687 . PMID 22517384. \n \n^ John J. Callaghan, Aaron G. Rosenberg, Harry E. Rubash (2007). The Adult Hip, Volume 1. Lippincott Williams & Wilkins. p. 958. ISBN 978-0-7817-5092-9. CS1 maint: Multiple names: authors list (link) \n\n^ Neumann, Daniel R.P.; Thaler, Christoph; Hitzl, Wolfgang; Huber, Monika; Hofst\u00e4dter, Thomas; Dorn, Ulrich (2010). \"Long-Term Results of a Contemporary Metal-on-Metal Total Hip Arthroplasty\". The Journal of Arthroplasty. 25 (5): 700\u2013708. doi:10.1016\/j.arth.2009.05.018. ISSN 0883-5403. \n\n^ a b Roth, Trenton D.; Maertz, Nathan A.; Parr, J. Andrew; Buckwalter, Kenneth A.; Choplin, Robert H. (2012). \"CT of the Hip Prosthesis: Appearance of Components, Fixation, and Complications\". RadioGraphics. 32 (4): 1089\u20131107. doi:10.1148\/rg.324115183. ISSN 0271-5333. \n\n^ Steffen Breusch, Henrik Malchau (2005). The Well-Cemented Total Hip Arthroplasty: Theory and Practice. Springer Science & Business Media. p. 336. ISBN 978-3-540-24197-3. \n\n^ Angerame, Marc R.; Fehring, Thomas K.; Masonis, John L.; Mason, J. Bohannon; Odum, Susan M.; Springer, Bryan D. (February 2018). \"Early Failure of Primary Total Hip Arthroplasty: Is Surgical Approach a Risk Factor?\". The Journal of Arthroplasty. doi:10.1016\/j.arth.2018.01.014. \n\n^ Pandit H, Glyn-Jones S, McLardy-Smith P, et al. (July 2008). \"Pseudotumours associated with metal-on-metal hip resurfacings\". J Bone Joint Surg Br. 90 (7): 847\u201351. doi:10.1302\/0301-620X.90B7.20213. PMID 18591590. \n\n^ Boardman DR, Middleton FR, Kavanagh TG (March 2006). \"A benign psoas mass following metal-on-metal resurfacing of the hip\". J Bone Joint Surg Br. 88 (3): 402\u20134. doi:10.1302\/0301-620X.88B3.16748. PMID 16498023. \r\nKorovessis P, Petsinis G, Repanti M, Repantis T (June 2006). \"Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up\". J Bone Joint Surg Am. 88 (6): 1183\u201391. doi:10.2106\/JBJS.D.02916. PMID 16757749. \n\n^ a b Hallab N, Merritt K, Jacobs JJ (March 2001). \"Metal sensitivity in patients with orthopaedic implants\". J Bone Joint Surg Am. 83-A (3): 428\u201336. PMID 11263649. \n\n^ http:\/\/www.epi.hss.state.ak.us\/bulletins\/docs\/b2010_14.pdf \n\n^ a b \"FDA seeks more advice on metal hip implants\". Reuters. 29 March 2012. Retrieved 20 May 2012 . \n\n^ Cot\u00e9, John (July 22, 2007). \"Hip replacement is not viewed as high-risk surgery; Death is rare, but underlying medical condition a factor\". San Francisco Chronicle. \n\n^ Medscape Conference Coverage, American Academy of Orthopaedic Surgeons (AAOS) 2009 Annual Meeting, AAOS 2009: Certain Factors Increase Risk for Death After Total Hip Arthroplasty, Barbara Boughton, March 3, 2009. \n\n^ Mikael, Mark M.; Hanssen, Arlen D.; Sierra, Rafael J. (2009). \"Failure of Metal-on-Metal Total Hip Arthroplasty Mimicking Hip Infection\". The Journal of Bone and Joint Surgery. American Volume. 2009 (91): 443\u2013446. doi:10.2106\/JBJS.H.00603. PMID 19181991. Retrieved 2010-05-07 . \n\n^ Meier, Barry (March 3, 2010). \"As Use of Metal-on-Metal Hip Implants Grows, Studies Raise Concerns\". The New York Times. \n\n^ Meier, Barry (March 3, 2010). \"Concerns Over 'Metal on Metal' Hip Implants\". The New York Times. \n\n^ \"Medical Device Alert: All metal-on-metal (MoM) hip replacements\". Medicines and Healthcare products Regulatory Agency. 22 April 2010. MDA\/2010\/033. Archived from the original on 25 April 2010. Retrieved 2010-05-07 . \n\n^ Table HT 46. Australian Orthopaedic Association National Joint Replacement Registry Annual Report. Adelaide: AOA; 2008 \n\n^ Milosev I, Trebse R, Kovac S, C\u00f6r A, Pisot V (June 2006). \"Survivorship and retrieval analysis of Sikomet metal-on-metal total hip replacements at a mean of seven years\". J Bone Joint Surg Am. 88 (6): 1173\u201382. doi:10.2106\/JBJS.E.00604. PMID 16757748. \n\n^ Smith AJ, Dieppe P, Vernon K, Porter M, Blom AW (March 2012). \"Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales\". Lancet. 379 (9822): 1199\u2013204. doi:10.1016\/S0140-6736(12)60353-5. PMID 22417410. \n\n^ Gallagher, James (13 March 2012). \"Metal-on-metal hip replacements 'high failure rate' \". BBC. Retrieved 20 May 2012 . \n\n^ Pijls, B. G.; Meessen, J. M. T. A.; Schoones, J. W.; Fiocco, M.; Heide, H. J. L. van der; Sedrakyan, A.; Nelissen, R. G. H. H. (2016). \"Increased Mortality in Metal-on-Metal versus Non-Metal-on-Metal Primary Total Hip Arthroplasty at 10 Years and Longer Follow-Up: A Systematic Review and Meta-Analysis\". PLOS One. 11 (6): e0156051. doi:10.1371\/journal.pone.0156051. ISSN 1932-6203. PMC 4905643 . PMID 27295038. \n\n^ Roberts, Michelle (5 March 2012). \"Surgeons call for end to metal hip replacements\". BBC. Retrieved 20 May 2012 . \n\n^ \"Metal-on-Metal Hip Implants\". Food and Drug Administration. February 10, 2011. Retrieved January 4, 2012 . \n\n^ \"Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee Meeting Announcement\". Food and Drug Administration. 27 March 2012. FDA-2012-N-0293. Retrieved 20 May 2012 . \n\n^ FDA Executive Summary Memorandum \u2013 Metal-on-Metal Hip Implant System (PDF) (Report). Food and Drug Administration. 27 June 2012. Retrieved 15 March 2013 . \n\n^ \"Concerns about Metal-on-Metal Hip Implants\". Food and Drug Administration. 17 January 2013. Retrieved 15 March 2013 . \n\n^ \"Study Suggests Women Have Higher Risk of Hip Implant Failure - For The Media - JAMA Network\". media.jamanetwork.com. \n\n^ Rising, Joshua P.; Reynolds, Ian S.; Sedrakyan, Art (2012). \"Delays and Difficulties in Assessing Metal-on-Metal Hip Implants\". New England Journal of Medicine. 367 (1): e1. doi:10.1056\/NEJMp1206794. PMID 22716934. \n\n^ Cibulka MT, White DM, Woehrle J, et al. (April 2009). \"Hip pain and mobility deficits\u2014hip osteoarthritis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the American Physical Therapy Association\". J Orthop Sports Phys Ther. 39 (4): A1\u201325. doi:10.2519\/jospt.2009.0301. PMC 3963282 . PMID 19352008. \n\n^ McDonald, S; Page, MJ; Beringer, K; Wasiak, J; Sprowson, A (2014). \"Preoperative education for hip or knee replacement\". The Cochrane Database of Systematic Reviews (published 13 May 2014) (5): CD003526. doi:10.1002\/14651858.CD003526.pub3. PMID 24820247. \n\n^ van der Meulen, M.C.H.; Allen, W.A.; Giddings, V.L.; Athanasiou, K.A.; Poser, R.D.; Goodman, S.B.; Smith, R.L.; Beaupr\u00e9, G.S. \"Effect of hemiarthroplasty on acetabular cartilage\". 1996 Project Reports. VA Palo Alto Health Care System's Bone and Joint Rehabilitation Research and Development Center. \n\n^ Jones, Carl; Briffa, Nikolai; Jacob, Joshua; Hargrove, Richard (2017). \"The Dislocated Hip Hemiarthroplasty: Current Concepts of Etiological factors and Management\". The Open Orthopaedics Journal. 11 (Suppl-7, M4): 1200\u20131212. doi:10.2174\/1874325001711011200. ISSN 1874-3250. \n\n^ Koutras C, Antoniou SA, Talias MA, Heep H (19 May 2015). \"Impact of Total Hip Resurfacing Arthroplasty on Health-Related Quality of Life Measures: A Systematic Review and Meta-Analysis\". J Arthroplasty. 30 (11): 1938\u201352. doi:10.1016\/j.arth.2015.05.014. PMID 26067708. \n\n^ van den Bekerom MP, Lamme B, Sermon A, Mulier M (August 2008). \"What is the evidence for viscosupplementation in the treatment of patients with hip osteoarthritis? Systematic review of the literature\". Arch Orthop Trauma Surg. 128 (8): 815\u2013823. doi:10.1007\/s00402-007-0447-z. PMID 17874246. \n\n^ Centeno CJ, Kisiday J, Freeman M, Schultz JR (July 2006). \"Partial regeneration of the human hip via autologous bone marrow nucleated cell transfer: A case study\". Pain Physician. 9 (3): 253\u20136. PMID 16886034. Archived from the original on 2009-02-12. \n\n^ Kurtz SM, Ong KL, Lau E, Widmer M, Maravic M, G\u00f3mez-Barrena E, de Pina Mde F, Manno V, Torre M, Walter WL, de Steiger R, Geesink RG, Peltola M, R\u00f6der C (2011). \"International survey of primary and revision total knee replacement\". Int Orthop. 35 (12): 1783\u20139. doi:10.1007\/s00264-011-1235-5. PMC 3224613 . PMID 21404023. \n\n^ Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, Jiranek WA, Berry DJ (2015). \"Prevalence of Total Hip and Knee Replacement in the United States\". J Bone Joint Surg Am. 97 (17): 1386\u201397. doi:10.2106\/JBJS.N.01141. PMC 4551172 . PMID 26333733. \n\n^ \"A study of cost variations for knee and hip replacement surgeries in the U.S.\" (PDF) . Blue Cross Blue Shield Association. 21 January 2015. Archived from the original (PDF) on 22 October 2015. Retrieved 4 October 2015 . \n\n^ \"History of Artificial Joints - ppt video online download\". slideplayer.com. \n\n^ Brand, RA; Mont, MA; Manring, M (2011). \"Biographical sketch: Themistocles Gluck (1853\u20131942)\". Clin. Orthop. Relat. Res. 469 (6): 1525\u20131527. doi:10.1007\/s11999-011-1836-8. PMC 3094624 . PMID 21403990. \n\n^ Gomez PF; Morcuende JA (2005). \"Early attempts at hip arthroplasty\u20141700s to 1950s\". Iowa Orthop J. 25: 25\u20139. PMC 1888777 . PMID 16089067. \n\n^ \"What You Need to Know About Joint Replacement Surgery\". about.com. \n\n\nExternal links \nEdheads Virtual Hip Surgery + Surgery Photos\nAAOS Hip Replacement\nvteOrthopedic surgery, operations\/surgeries and other procedures on bones and joints (ICD-9-CM V3 76\u201381, ICD-10-PCS 0P\u2013S)BonesFacial\nJaw reduction\nDentofacial osteotomy\nGenioplasty\/Mentoplasty\nChin augmentation\nOrthognathic surgery\nSpine\nCoccygectomy\nLaminotomy\nLaminectomy\nLaminoplasty\nCorpectomy\nFacetectomy\nForaminotomy\nVertebral fixation\nPercutaneous vertebroplasty\nUpper extremity\nAcromioplasty\nLower extremity\nFemoral head ostectomy\nAstragalectomy\nDistraction osteogenesis\nIlizarov apparatus\nPhemister graft\nGeneral\nOstectomy\nBone grafting\nOsteotomy\nEpiphysiodesis\nReduction\nInternal fixation\nExternal fixation\nTension band wiring\nCartilage\nArticular cartilage repair\nMicrofracture surgery\nKnee cartilage replacement therapy\nAutologous chondrocyte implantation\nJointsSpine\nArthrodesis\nSpinal fusion\nIntervertebral discs\nDiscectomy\nAnnuloplasty\nArthroplasty\nUpper extremity\nShoulder surgery\nShoulder replacement\nBankart repair\nWeaver\u2013Dunn procedure\nUlnar collateral ligament reconstruction\nHand surgery\nBrunelli procedure\nLower extremity\nHip resurfacing\nHip replacement\nRotationplasty\nAnterior cruciate ligament reconstruction\nKnee replacement\/Unicompartmental knee arthroplasty\nAnkle replacement\nBrostr\u00f6m procedure\nTriple arthrodesis\nGeneral\nArthrotomy\nArthroplasty\nSynovectomy\nArthroscopy\nReplacement joint\nimaging: Arthrogram\nArthrocentesis\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Hip_replacement\">https:\/\/www.limswiki.org\/index.php\/Hip_replacement<\/a>\n\t\t\t\t\tCategories: Implants (medicine)Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 29 February 2016, at 23:07.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 583 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","18026209e7901858227ab2cae8f033cf_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Hip_replacement skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Hip replacement<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about human hip replacement. For hip replacement in animals, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement_(animal)\" title=\"Hip replacement (animal)\" rel=\"external_link\" target=\"_blank\">Hip replacement (animal)<\/a>.<\/div>\n\n<p><b>Hip replacement<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgical<\/a> procedure in which the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip\" title=\"Hip\" rel=\"external_link\" target=\"_blank\">hip<\/a> joint is replaced by a prosthetic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_(medicine)\" title=\"Implant (medicine)\" rel=\"external_link\" target=\"_blank\">implant<\/a>, that is, a <b>hip prosthesis<\/b>. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement\" title=\"Joint replacement\" rel=\"external_link\" target=\"_blank\">joint replacement<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopaedic_surgery\" class=\"mw-redirect\" title=\"Orthopaedic surgery\" rel=\"external_link\" target=\"_blank\">orthopaedic surgery<\/a> is generally conducted to relieve <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis\" title=\"Arthritis\" rel=\"external_link\" target=\"_blank\">arthritis<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pain\" title=\"Pain\" rel=\"external_link\" target=\"_blank\">pain<\/a> or in some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_fracture\" title=\"Hip fracture\" rel=\"external_link\" target=\"_blank\">hip fractures<\/a>. A total hip replacement (total hip arthroplasty) consists of replacing both the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetabulum\" title=\"Acetabulum\" rel=\"external_link\" target=\"_blank\">acetabulum<\/a> and the femoral head while <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemiarthroplasty\" class=\"mw-redirect\" title=\"Hemiarthroplasty\" rel=\"external_link\" target=\"_blank\">hemiarthroplasty<\/a> generally only replaces the femoral head. Hip replacement is currently one of the most common orthopaedic operations, though patient satisfaction short- and long-term varies widely. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.<sup id=\"rdp-ebb-cite_ref-ifhp_1-0\" class=\"reference\"><a href=\"#cite_note-ifhp-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<p>Total hip replacement is most commonly used to treat joint failure caused by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoarthritis\" title=\"Osteoarthritis\" rel=\"external_link\" target=\"_blank\">osteoarthritis<\/a>. Other indications include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rheumatoid_arthritis\" title=\"Rheumatoid arthritis\" rel=\"external_link\" target=\"_blank\">rheumatoid arthritis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Avascular_necrosis\" title=\"Avascular necrosis\" rel=\"external_link\" target=\"_blank\">avascular necrosis<\/a>, , <a href=\"https:\/\/en.wikipedia.org\/wiki\/Protrusio_acetabuli\" title=\"Protrusio acetabuli\" rel=\"external_link\" target=\"_blank\">protrusio acetabuli<\/a>, certain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_fracture\" title=\"Hip fracture\" rel=\"external_link\" target=\"_blank\">hip fractures<\/a>, benign and malignant <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_tumor\" title=\"Bone tumor\" rel=\"external_link\" target=\"_blank\">bone tumors<\/a>, arthritis associated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paget%27s_disease_of_bone\" title=\"Paget's disease of bone\" rel=\"external_link\" target=\"_blank\">Paget's disease<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ankylosing_spondylitis\" title=\"Ankylosing spondylitis\" rel=\"external_link\" target=\"_blank\">ankylosing spondylitis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Juvenile_rheumatoid_arthritis\" class=\"mw-redirect\" title=\"Juvenile rheumatoid arthritis\" rel=\"external_link\" target=\"_blank\">juvenile rheumatoid arthritis<\/a>. The aims of the procedure are pain relief and improvement in hip function. Hip replacement is usually considered only after other therapies, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_therapy\" title=\"Physical therapy\" rel=\"external_link\" target=\"_blank\">physical therapy<\/a> and pain medications, have failed.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Modern_process\">Modern process<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:162px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_components.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/da\/Hip_prosthesis_components.jpg\/160px-Hip_prosthesis_components.jpg\" width=\"160\" height=\"197\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_components.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Main components of a hip prosthesis<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0a\/Hip_prosthesis.jpg\/220px-Hip_prosthesis.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a> hip prosthesis, with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic\" title=\"Ceramic\" rel=\"external_link\" target=\"_blank\">ceramic<\/a> head and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> acetabular cup<\/div><\/div><\/div>\n<p>The modern artificial joint owes much to the 1962 work of Sir <a href=\"https:\/\/en.wikipedia.org\/wiki\/John_Charnley\" title=\"John Charnley\" rel=\"external_link\" target=\"_blank\">John Charnley<\/a> at Wrightington Hospital. His work in the field of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tribology\" title=\"Tribology\" rel=\"external_link\" target=\"_blank\">tribology<\/a> resulted in a design that almost completely replaced the other designs by the 1970s. Charnley's design consisted of three parts:\n<\/p>\n<ol><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_Steel\" class=\"mw-redirect\" title=\"Stainless Steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a> one-piece femoral stem and head<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> (originally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Teflon\" class=\"mw-redirect\" title=\"Teflon\" rel=\"external_link\" target=\"_blank\">Teflon<\/a>), acetabular component, both of which were fixed to the bone using<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Poly(methyl_methacrylate)\" title=\"Poly(methyl methacrylate)\" rel=\"external_link\" target=\"_blank\">PMMA<\/a> (acrylic) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_cement\" title=\"Bone cement\" rel=\"external_link\" target=\"_blank\">bone cement<\/a><\/li><\/ol>\n<p>The replacement joint, which was known as the Low Friction <a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroplasty\" title=\"Arthroplasty\" rel=\"external_link\" target=\"_blank\">Arthroplasty<\/a>, was lubricated with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Synovial_fluid\" title=\"Synovial fluid\" rel=\"external_link\" target=\"_blank\">synovial fluid<\/a>. The small femoral head (<span class=\"frac nowrap\"><sup>7<\/sup>⁄<sub>8<\/sub><\/span> in (22.2 mm)) was chosen for Charnley's belief that it would have lower friction against the acetabular component and thus wear out the acetabulum more slowly. Unfortunately, the smaller head dislocated more easily. Alternative designs with larger heads such as the Mueller prosthesis were proposed. Stability was improved, but acetabular wear and subsequent failure rates were increased with these designs. The Teflon acetabular components of Charnley's early designs failed within a year or two of implantation. This prompted a search for a more suitable material. A German salesman showed a polyethylene gear sample to Charnley's machinist, sparking the idea to use this material for the acetabular component. The ultra high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_weight\" class=\"mw-redirect\" title=\"Molecular weight\" rel=\"external_link\" target=\"_blank\">molecular weight<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene\" title=\"Polyethylene\" rel=\"external_link\" target=\"_blank\">polyethylene<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/UHMWPE\" class=\"mw-redirect\" title=\"UHMWPE\" rel=\"external_link\" target=\"_blank\">UHMWPE<\/a> acetabular component was introduced in 1962. Charnley's other major contribution was to use polymethylmethacrylate (PMMA) bone cement to attach the two components to the bone. For over two decades, the Charnley Low Friction Arthroplasty, and derivative designs were the most used systems in the world. It formed the basis for all modern hip implants.\n<\/p><p>The Exeter hip stem was developed in the United Kingdom during the same time as the Charnley device. Its development occurred following a collaboration between Orthopaedic Surgeon <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robin_Ling\" title=\"Robin Ling\" rel=\"external_link\" target=\"_blank\">Robin Ling<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Exeter\" title=\"University of Exeter\" rel=\"external_link\" target=\"_blank\">University of Exeter<\/a> engineer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clive_Lee\" title=\"Clive Lee\" rel=\"external_link\" target=\"_blank\">Clive Lee<\/a> and it was first implanted at the Princess Elizabeth Orthopaedic Hospital in Exeter in 1970.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> The Exeter Hip is a cemented device, but with a slightly different stem geometry. Both designs have shown excellent long-term durability when properly placed and are still widely used in slightly modified versions.\n<\/p><p>Early implant designs had the potential to loosen from their attachment to the bones, typically becoming painful ten to twelve years after placement. In addition, erosion of the bone around the implant was seen on x-rays. Initially, surgeons believed this was caused by an abnormal reaction to the cement holding the implant in place. That belief prompted a search for an alternative method to attach the implants. The Austin Moore device had a small hole in the stem into which bone graft was placed before implanting the stem. It was hoped bone would then grow through the window over time and hold the stem in position. Success was unpredictable and the fixation not very robust. In the early 1980s, surgeons in the United States applied a coating of small beads to the Austin Moore device and implanted it without cement. The beads were constructed so that gaps between beads matched the size of the pores in native bone. Over time, bone cells from the patient would grow into these spaces and fix the stem in position. The stem was modified slightly to fit more tightly into the femoral canal, resulting in the Anatomic Medullary Locking (AML) stem design. With time, other forms of stem surface treatment and stem geometry have been developed and improved.\n<\/p><p>Initial hip designs were made of a one-piece femoral component and a one-piece acetabular component. Current designs have a femoral stem and separate head piece. Using an independent head allows the surgeon to adjust leg length (some heads seat more or less onto the stem) and to select from various materials from which the head is formed. A modern acetabulum component is also made up of two parts: a metal shell with a coating for bone attachment and a separate liner. First the shell is placed. Its position can be adjusted, unlike the original cemented cup design which are fixed in place once the cement sets. When proper positioning of the metal shell is obtained, the surgeon may select a liner made from various materials.\n<\/p><p>To combat loosening caused by polyethylene wear debris, hip manufacturers developed improved and novel materials for the acetabular liners. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic\" title=\"Ceramic\" rel=\"external_link\" target=\"_blank\">Ceramic<\/a> heads mated with regular polyethylene liners or a ceramic liner were the first significant alternative. Metal liners to mate with a metal head were also developed. At the same time these designs were being developed, the problems that caused polyethylene wear were determined and manufacturing of this material improved. Highly crosslinked UHMWPE was introduced in the late 1990s. The most recent data comparing the various bearing surfaces has shown no clinically significant differences in their performance. Potential early problems with each material are discussed below. Performance data after 20 or 30 years may be needed to demonstrate significant differences in the devices. All newer materials allow use of larger diameter femoral heads. Use of larger heads significantly decreases the chance of the hip dislocating, which remains the greatest complication of the surgery.\n<\/p><p>When currently available implants are used, cemented stems tend to have a better longevity than uncemented stems. No significant difference is observed in the clinical performance of the various methods of surface treatment of uncemented devices. Uncemented stems are selected for patients with good quality bone that can resist the forces needed to drive the stem in tightly. Cemented devices are typically selected for patients with poor quality bone who are at risk of fracture during stem insertion. Cemented stems are less expensive due to lower manufacturing cost, but require good surgical technique to place them correctly. Uncemented stems can cause pain with activity in up to 20% of patients during the first year after placement as the bone adapts to the device. This is rarely seen with cemented stems.\n<\/p><p>Once an uncommon operation reserved for frail patients with a limited life expectancy, hip replacement is now common, even among active <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sportsperson\" class=\"mw-redirect\" title=\"Sportsperson\" rel=\"external_link\" target=\"_blank\">athletes<\/a> including race car drivers <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bobby_Labonte\" title=\"Bobby Labonte\" rel=\"external_link\" target=\"_blank\">Bobby Labonte<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dale_Jarrett\" title=\"Dale Jarrett\" rel=\"external_link\" target=\"_blank\">Dale Jarrett<\/a>, and the 8-time Major-winning American golfer <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tom_Watson_(golfer)\" title=\"Tom Watson (golfer)\" rel=\"external_link\" target=\"_blank\">Tom Watson<\/a>, who shot a 67 in the opening round of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Masters_Tournament\" title=\"Masters Tournament\" rel=\"external_link\" target=\"_blank\">Masters Tournament<\/a> in the year following his operation.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Techniques\">Techniques<\/span><\/h2>\n<p>There are several incisions, defined by their relation to the gluteus medius. The approaches are posterior (Moore), lateral (Hardinge or Liverpool),<sup id=\"rdp-ebb-cite_ref-pmid9498150_4-0\" class=\"reference\"><a href=\"#cite_note-pmid9498150-4\" rel=\"external_link\">[4]<\/a><\/sup> antero-lateral (Watson-Jones),<sup id=\"rdp-ebb-cite_ref-titleAnterolateral_Approach_to_Hip_Joint:_(Watson_Jones)_-_Wheeless'_Textbook_of_Orthopaedics_5-0\" class=\"reference\"><a href=\"#39;_Textbook_of_Orthopaedics-5\" rel=\"external_link\">[5]<\/a><\/sup> anterior (Smith-Petersen)<sup id=\"rdp-ebb-cite_ref-titleAnterior_Approach_to_the_Hip_(Smith_Petersen)_-_Wheeless'_Textbook_of_Orthopaedics_6-0\" class=\"reference\"><a href=\"#39;_Textbook_of_Orthopaedics-6\" rel=\"external_link\">[6]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greater_trochanter\" title=\"Greater trochanter\" rel=\"external_link\" target=\"_blank\">greater trochanter<\/a> osteotomy. There is no compelling evidence in the literature for any particular approach, but consensus of professional opinion favours either modified anterolateral (Watson-Jones) or posterior approach.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (November 2007)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Posterior_approach\">Posterior approach<\/span><\/h3>\n<p>The <i>posterior (Moore or Southern) approach<\/i> accesses the joint and capsule through the back, taking <a href=\"https:\/\/en.wikipedia.org\/wiki\/Piriformis_muscle\" title=\"Piriformis muscle\" rel=\"external_link\" target=\"_blank\">piriformis muscle<\/a> and the short external rotators of the femur. This approach gives excellent access to the acetabulum and femur and preserves the hip <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abduction_(kinesiology)\" class=\"mw-redirect\" title=\"Abduction (kinesiology)\" rel=\"external_link\" target=\"_blank\">abductors<\/a> and thus minimizes the risk of abductor dysfunction post operatively. It has the advantage of becoming a more extensile approach if needed. Critics cite a higher dislocation rate, although repair of the capsule, piriformis and the short external rotators along with use of modern large diameter head balls reduces this risk.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Lateral_approach\">Lateral approach<\/span><\/h3>\n<p>The <i>lateral approach<\/i> is also commonly used for hip replacement. The approach requires elevation of the hip abductors (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteus_medius\" title=\"Gluteus medius\" rel=\"external_link\" target=\"_blank\">gluteus medius<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gluteus_minimus\" title=\"Gluteus minimus\" rel=\"external_link\" target=\"_blank\">gluteus minimus<\/a>) to access the joint. The abductors may be lifted up by osteotomy of the greater trochanter and reapplying it afterwards using wires (as per Charnley),<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2007)\">citation needed<\/span><\/a><\/i>]<\/sup> or may be divided at their tendinous portion, or through the functional tendon (as per Hardinge) and repaired using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">sutures<\/a>. Although this approach has a lower dislocation risk than the posterior approach, critics note that occasionally the abductor muscles do not heal back on, leading to pain and weakness which is often very difficult to treat.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Antero-lateral_approach\">Antero-lateral approach<\/span><\/h3>\n<p>The <i>anterolateral approach<\/i> develops the interval between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tensor_fasciae_latae\" class=\"mw-redirect\" title=\"Tensor fasciae latae\" rel=\"external_link\" target=\"_blank\">tensor fasciae latae<\/a> and the gluteus medius. The Gluteus medius, gluteus minimus and hip capsule are detached from the anterior (front) for the greater trochanter and femoral neck and then repaired with heavy suture after the replacement of the joint.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Anterior_approach\">Anterior approach<\/span><\/h3>\n<p>The <i>anterior approach<\/i> uses an interval between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sartorius_muscle\" title=\"Sartorius muscle\" rel=\"external_link\" target=\"_blank\">sartorius muscle<\/a> and tensor fasciae latae. Dr. Joel Matta and Dr. Bert Thomas have adapted this approach, which was commonly used for pelvic fracture repair surgery, for use when performing hip replacement. When used with older hip implant systems that had a small diameter head, dislocation rates were reduced compared to surgery performed through a posterior approach. With modern implant designs, dislocation rates are similar between the anterior and posterior approaches.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> The anterior approach has been shown in studies to variably improve early functional recovery, with possible complications of femoral component loosening and early revision compared to other approaches<sup id=\"rdp-ebb-cite_ref-Direct_Anterior_Approach_8-0\" class=\"reference\"><a href=\"#cite_note-Direct_Anterior_Approach-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-James_I_2016_9-0\" class=\"reference\"><a href=\"#cite_note-James_I_2016-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Minimally_invasive_approaches\">Minimally invasive approaches<\/span><\/h3>\n<p>The dual incision approach and other minimally invasive surgery seeks to reduce soft tissue damage through reducing the size of the incision. However, component positioning accuracy and visualization of the bone structures can be significantly impaired as the approaches get smaller. This can result in unintended fractures and soft tissue injury. The majority of current orthopedic surgeons use a \"minimally invasive\" approach compared to traditional approaches which were quite large comparatively.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-assisted_surgery\" title=\"Computer-assisted surgery\" rel=\"external_link\" target=\"_blank\">Computer-assisted surgery<\/a> and robotic surgery techniques are also available to guide the surgeon to provide enhanced accuracy. Several commercial CAS and robotic systems are available for use worldwide. Improved patient outcomes and reduced complications have not been demonstrated when these systems are used when compared to standard techniques.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Implants\">Implants<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MetalonmetalhipreplaceMark.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/33\/MetalonmetalhipreplaceMark.png\/220px-MetalonmetalhipreplaceMark.png\" width=\"220\" height=\"183\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:MetalonmetalhipreplaceMark.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Metal on metal prosthetic hip<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip-replacement.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Hip-replacement.jpg\/170px-Hip-replacement.jpg\" width=\"170\" height=\"294\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip-replacement.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Cement-free implant sixteen days after surgery. Femoral component is cobalt chromium combined with titanium which induces bone growth into the implant. Ceramic head. Acetabular cup coated with bone growth-inducing material and held temporarily in place with a single screw.<\/div><\/div><\/div>\n<p>The prosthetic implant used in hip replacement consists of three parts: the acetabular cup, the femoral component, and the articular interface. Options exist for different people and indications. The evidence for a number of newer devices is not very good, including: ceramic-on-ceramic bearings, modular femoral necks, and uncemented monoblock cups.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> Correct selection of the prosthesis is important.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Acetabular_cup\">Acetabular cup<\/span><\/h3>\n<p>The acetabular cup is the component which is placed into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetabulum\" title=\"Acetabulum\" rel=\"external_link\" target=\"_blank\">acetabulum<\/a> (hip socket). Cartilage and bone are removed from the acetabulum and the acetabular cup is attached using friction or cement. Some acetabular cups are one piece, while others are modular. One-piece (monobloc) shells are either UHMWPE (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultra-high-molecular-weight_polyethylene\" title=\"Ultra-high-molecular-weight polyethylene\" rel=\"external_link\" target=\"_blank\">ultra-high-molecular-weight polyethylene<\/a>) or metal, they have their articular surface machined on the inside surface of the cup and do not rely on a locking mechanism to hold a liner in place. A monobloc polyethylene cup is cemented in place while a metal cup is held in place by a metal coating on the outside of the cup. Modular cups consist of two pieces, a shell and liner. The shell is made of metal; the outside has a porous coating while the inside contains a locking mechanism designed to accept a liner. Two types of porous coating used to form a friction fit are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sintering\" title=\"Sintering\" rel=\"external_link\" target=\"_blank\">sintered<\/a> beads and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foam_metal\" class=\"mw-redirect\" title=\"Foam metal\" rel=\"external_link\" target=\"_blank\">foam metal<\/a> design to mimic the trabeculae of cancellous bone and initial stability is influenced by under-reaming and insertion force.<sup id=\"rdp-ebb-cite_ref-Amirouche_17-0\" class=\"reference\"><a href=\"#cite_note-Amirouche-17\" rel=\"external_link\">[17]<\/a><\/sup> Permanent fixation is achieved as bone grows onto or into the porous coating. Screws can be used to lag the shell to the bone providing even more fixation. Polyethylene liners are placed into the shell and connected by a rim locking mechanism; ceramic and metal liners are attached with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Morse_taper\" class=\"mw-redirect\" title=\"Morse taper\" rel=\"external_link\" target=\"_blank\">Morse taper<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (July 2012)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Femoral_component\">Femoral component<\/span><\/h3>\n<p>The femoral component is the component that fits in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femur\" title=\"Femur\" rel=\"external_link\" target=\"_blank\">femur<\/a> (thigh bone). Bone is removed and the femur is shaped to accept the femoral stem with attached prosthetic femoral head (ball). There are two types of fixation: cemented and uncemented. Cemented stems use acrylic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_cement\" title=\"Bone cement\" rel=\"external_link\" target=\"_blank\">bone cement<\/a> to form a mantle between the stem and to the bone. Uncemented stems use friction, shape and surface coatings to stimulate bone to remodel and bond to the implant. Stems are made of multiple materials (titanium, cobalt chromium, stainless steel, and polymer composites) and they can be monolithic or modular. Modular components consist of different head dimensions and\/or modular neck orientations; these attach via a taper similar to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Morse_taper\" class=\"mw-redirect\" title=\"Morse taper\" rel=\"external_link\" target=\"_blank\">Morse taper<\/a>. These options allow for variability in leg length, offset and version. Femoral heads are made of metal or ceramic material. Metal heads, made of cobalt chromium for hardness, are machined to size and then polished to reduce wear of the socket liner. Ceramic heads are more smooth than polished metal heads, have a lower coefficient of friction than a cobalt chrome head, and in theory will wear down the socket liner more slowly. As of early 2011, follow-up studies in patients have not demonstrated significant reductions in wear rates between the various types of femoral heads on the market. Ceramic implants are more brittle and may break after being implanted.\n<\/p><h3><span class=\"mw-headline\" id=\"Articular_interface\">Articular interface<\/span><\/h3>\n<p>The articular interface is not part of either implant, rather it is the area between the acetabular cup and femoral component. The articular interface of the hip is a simple ball and socket joint. Size, material properties and machining <a href=\"https:\/\/en.wikipedia.org\/wiki\/Engineering_tolerance\" title=\"Engineering tolerance\" rel=\"external_link\" target=\"_blank\">tolerances<\/a> at the articular interface can be selected based on patient demand to optimise implant function and longevity whilst mitigating associated risks. The interface size is measured by the outside diameter of the head or the inside diameter of the socket. Common sizes of femoral heads are 28 mm (1.1 in), 32 mm (1.3 in) and 36 mm (1.4 in). While 22.25 mm (<span class=\"frac nowrap\"><sup>7<\/sup>⁄<sub>8<\/sub><\/span> in) was common in the first modern prostheses, now even larger sizes are available from 38 to over 54 mm. Larger-diameter heads lead to increased stability and range of motion whilst lowering the risk of dislocation. At the same time they are also subject to higher stresses such as friction and inertia. Different combinations of materials have different physical properties which can be coupled to reduce the amount of wear debris generated by friction. Typical pairings of materials include metal on polyethylene (MOP), metal on crosslinked polyethylene (MOXP), ceramic on ceramic (COC), ceramic on crosslinked polyethylene (COXP) and metal on metal (MOM). Each combination has different advantages and disadvantages.\n<\/p><h2><span class=\"mw-headline\" id=\"Configuration\">Configuration<\/span><\/h2>\n<p>Post-operative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Projectional_radiography\" title=\"Projectional radiography\" rel=\"external_link\" target=\"_blank\">projectional radiography<\/a> is routinely performed to ensure proper configuration of hip prostheses.\n<\/p><p>The direction of the acetabular cup influences the range of motion of the leg, and also affects the risk of dislocation.<sup id=\"rdp-ebb-cite_ref-Watt_18-0\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup> For this purpose, the <i>acetabular inclination<\/i> and the <i>acetabular anteversion<\/i> are measurements of cup angulation in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronal_plane\" title=\"Coronal plane\" rel=\"external_link\" target=\"_blank\">coronal plane<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sagittal_plane\" title=\"Sagittal plane\" rel=\"external_link\" target=\"_blank\">sagittal plane<\/a>, respectively.\n<\/p>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Acetabular_inclination_of_hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/92\/Acetabular_inclination_of_hip_prosthesis.jpg\/230px-Acetabular_inclination_of_hip_prosthesis.jpg\" width=\"230\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Acetabular inclination.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-0\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup> This parameter is calculated on an anteroposterior radiograph as the angle between a line through the lateral and medial margins of the acetabular cup and the <i>transischial line<\/i> which is tangential to the inferior margins of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ischium\" title=\"Ischium\" rel=\"external_link\" target=\"_blank\">ischium<\/a> bones.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-1\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:23.5px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Range_of_acetabular_inclination.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/91\/Range_of_acetabular_inclination.png\/230px-Range_of_acetabular_inclination.png\" width=\"230\" height=\"103\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Acetabular inclination is normally between 30 and 50\u00b0.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-2\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup> A larger angle increases the risk of dislocation.<sup id=\"rdp-ebb-cite_ref-Watt_18-1\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:15px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Acetabular_anteversion_of_hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/Acetabular_anteversion_of_hip_prosthesis.jpg\/104px-Acetabular_anteversion_of_hip_prosthesis.jpg\" width=\"104\" height=\"120\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Acetabular anteversion.<sup id=\"rdp-ebb-cite_ref-ShinLee2015_20-0\" class=\"reference\"><a href=\"#cite_note-ShinLee2015-20\" rel=\"external_link\">[20]<\/a><\/sup> This parameter is calculated on a lateral radiograph as the angle between the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transverse_plane\" title=\"Transverse plane\" rel=\"external_link\" target=\"_blank\">transverse plane<\/a> and a line going through the (anterior and posterior) margins of the acetabular cup.<sup id=\"rdp-ebb-cite_ref-ShinLee2015_20-1\" class=\"reference\"><a href=\"#cite_note-ShinLee2015-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:22px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Range_of_acetabular_anteversion.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/Range_of_acetabular_anteversion.png\/230px-Range_of_acetabular_anteversion.png\" width=\"230\" height=\"106\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Acetabular anteversion is normally between 5 and 25\u00b0.<sup id=\"rdp-ebb-cite_ref-Watt_18-2\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup> An anteversion below or above this range increases the risk of dislocation.<sup id=\"rdp-ebb-cite_ref-Watt_18-3\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup> There is an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intra-individual_variability\" class=\"mw-redirect\" title=\"Intra-individual variability\" rel=\"external_link\" target=\"_blank\">intra-individual variability<\/a> in this method because the pelvis may be tilted in various degrees in relation to the transverse plane.<sup id=\"rdp-ebb-cite_ref-Watt_18-4\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:24px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Leg_length_discrepancy_after_hip_replacement.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d7\/Leg_length_discrepancy_after_hip_replacement.jpg\/230px-Leg_length_discrepancy_after_hip_replacement.jpg\" width=\"230\" height=\"102\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p><i>Leg length discrepancy<\/i> after hip replacement is calculated as the vertical distance between the middle of the minor trochanters, using the acetabular tear drops<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-3\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup> or the transischial line<sup id=\"rdp-ebb-cite_ref-Watt_18-5\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup> as references for the horizontal plane. A discrepancy of up to 1 cm is generally tolerated.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-4\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Watt_18-6\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 265px\"><div style=\"width: 265px\">\n\t\t\t<div class=\"thumb\" style=\"width: 260px;\"><div style=\"margin:22px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Center_of_rotation_of_hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Center_of_rotation_of_hip_prosthesis.jpg\/230px-Center_of_rotation_of_hip_prosthesis.jpg\" width=\"230\" height=\"106\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p><i>Center of rotation<\/i>: The horizontal center of rotation is calculated as the distance between the acetabular teardrop and the center of the head (or caput) of the prosthesis and\/or the native femoral head on the contralateral side.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-5\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup> The vertical center of rotation instead uses the transischial line for reference.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-6\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup> The parameter should be equal on both sides.<sup id=\"rdp-ebb-cite_ref-Vanrusselt2015_19-7\" class=\"reference\"><a href=\"#cite_note-Vanrusselt2015-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<p>Risks and complications in hip replacement are similar to those associated with all <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement#Risks_and_complications\" title=\"Joint replacement\" rel=\"external_link\" target=\"_blank\">joint replacements<\/a>. They can include infection, dislocation, limb length inequality, loosening, impingement, osteolysis, metal sensitivity, nerve palsy, chronic pain and death. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bariatric_surgery\" title=\"Bariatric surgery\" rel=\"external_link\" target=\"_blank\">Weight loss surgery<\/a> before a hip replacement does not appear to change outcomes.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Infection\">Infection<\/span><\/h3>\n<p>Infection is one of the most common causes for revision of a total hip replacement, along with loosening and dislocation. The incidence of infection in primary hip replacement is around 1% or less in the United States.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup> Risk factors for infection include obesity, diabetes, smoking, immunosuppressive medications or diseases, and history of infection.\n<\/p><p>Modern diagnosis of infection around a total knee replacement is based on the Musculoskeletal Infection Society (MSIS) criteria.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup> They are:\n<\/p><p>1.There is a sinus tract communicating with the prosthesis; or\n<p>2. A pathogen is isolated by culture from at least two separate tissue or fluid samples obtained from the affected prosthetic joint; \nor\n<\/p>\n<\/p><p>Four of the following six criteria exist:\n<\/p><p>1.Elevated serum erythrocyte sedimentation rate (ESR>30mm\/hr) and serum C-reactive protein (CRP>10 mg\/L) concentration,\n<\/p><p>2.Elevated synovial leukocyte count,\n<\/p><p>3.Elevated synovial neutrophil percentage (PMN%),\n<\/p><p>4.Presence of purulence in the affected joint,\n<\/p><p>5.Isolation of a microorganism in one culture of periprosthetic tissue or fluid, or\n<\/p><p>6.Greater than five neutrophils per high-power field in five high-power fields observed from histologic analysis of periprosthetic tissue at \u00d7400 magnification.\n<\/p><p>None of the above laboratory tests has 100% sensitivity or specificity for diagnosing infection. Specificity improves when the tests are performed in patients in whom clinical suspicion exists. ESR and CRP remain good 1st line tests for screening (high sensitivity, low specificity). Aspiration of the joint remains the test with the highest specificity for confirming infection.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Dislocation\">Dislocation<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dislocated_hip_replacement.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/76\/Dislocated_hip_replacement.jpg\/170px-Dislocated_hip_replacement.jpg\" width=\"170\" height=\"226\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dislocated_hip_replacement.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Dislocated artificial hip<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:162px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_liner_creep_and_wear.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d9\/Hip_prosthesis_liner_creep_and_wear.png\/160px-Hip_prosthesis_liner_creep_and_wear.png\" width=\"160\" height=\"153\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_liner_creep_and_wear.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Liner wear, particularly when over 2 mm, increases the risk of dislocation.<sup id=\"rdp-ebb-cite_ref-berry2012_24-0\" class=\"reference\"><a href=\"#cite_note-berry2012-24\" rel=\"external_link\">[24]<\/a><\/sup> Liner creep, on the other hand, is normal remoulding.<sup id=\"rdp-ebb-cite_ref-Watt_18-7\" class=\"reference\"><a href=\"#cite_note-Watt-18\" rel=\"external_link\">[18]<\/a><\/sup><\/div><\/div><\/div>\n<p>Dislocation is the most common complication of hip replacement surgery. The most common causes vary by the duration since the surgery.\n<\/p><p>Hip prosthesis <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_dislocation\" title=\"Joint dislocation\" rel=\"external_link\" target=\"_blank\">dislocation<\/a> mostly occurs in the first 3 months after insertion, mainly because of incomplete scar formation and relaxed soft tissues.<sup id=\"rdp-ebb-cite_ref-berry2012_24-1\" class=\"reference\"><a href=\"#cite_note-berry2012-24\" rel=\"external_link\">[24]<\/a><\/sup> It takes eight to twelve weeks for the soft tissues injured or cut during surgery to heal. During this period, the hip ball can come out of the socket. The chance of this is diminished if less tissue is cut, if the tissue cut is repaired and if large diameter head balls are used.\n<\/p><p>Dislocations occurring between 3 months and 5 years after insertion usually occur due to malposition of the components, or dysfunction of nearby muscles.<sup id=\"rdp-ebb-cite_ref-berry2012_24-2\" class=\"reference\"><a href=\"#cite_note-berry2012-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p><p>Risk factors of late dislocation (after 5 years) mainly include:<sup id=\"rdp-ebb-cite_ref-berry2012_24-3\" class=\"reference\"><a href=\"#cite_note-berry2012-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p>\n<ul><li>Female gender<\/li>\n<li>Younger age at primary hip arthroplasty<\/li>\n<li>Previous <a href=\"https:\/\/en.wikipedia.org\/wiki\/Subluxation\" title=\"Subluxation\" rel=\"external_link\" target=\"_blank\">subluxation<\/a> without complete dislocation<\/li>\n<li>Previous trauma<\/li>\n<li>Substantial weight loss<\/li>\n<li>Recent onset or progression of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dementia\" title=\"Dementia\" rel=\"external_link\" target=\"_blank\">dementia<\/a> or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neurological_disorder\" title=\"Neurological disorder\" rel=\"external_link\" target=\"_blank\">neurological disorder<\/a><\/li>\n<li>Malposition of the cup<\/li>\n<li>Wear of the liner, particularly when it causes movement of the head of more than 2 mm within the cup compared to its original position<\/li>\n<li>Prosthesis loosening with migration<\/li><\/ul>\n<p>Surgeons who perform more of the operations each year tend to have fewer patients dislocate. Doing the surgery from an anterior approach seems to lower dislocation rates when small diameter heads are used, but the benefit has not been shown when compared to modern posterior incisions with the use of larger diameter heads. The use of larger diameter head size does in it self decrease the risk of dislocation, even though this correlation is only found in head sizes up to 28 mm, thereafter no additional decrease in dislocation rate is found.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> Patients can decrease the risk further by keeping the leg out of certain positions during the first few months after surgery.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Limb_Length_Inequality\">Limb Length Inequality<\/span><\/h3>\n<p>Most adults prior to a hip replacement have a limb length inequality of 0\u20132 cm which they were born with and which causes no clinical deficits.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> It is common for patients to feel a limb length inequality after total hip replacement.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> Sometimes the leg seems long immediately after surgery when in fact both are equal length. An arthritic hip can develop contractures that make the leg behave as if it is short. When these are relieved with replacement surgery and normal motion and function are restored, the body feels that the limb is now longer than it was. This feeling usually subsides by 6 months after surgery as the body adjusts to the new hip joint. The cause of this feeling is variable, and usually related to abductor muscle weakness, pelvic obliquity, and minor lengthening of the hip during surgery (<1 cm) to achieve stability and restore the joint to pre-arthritic mechanics. If the limb length difference remains bothersome to the patient more than 6 months after surgery, a shoe lift can be used. Only in extreme cases is surgery required for correction.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Fracture\">Fracture<\/span><\/h3>\n<p>Bones with internal fixation devices in situ are at risk of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Periprosthetic\" title=\"Periprosthetic\" rel=\"external_link\" target=\"_blank\">periprosthetic<\/a> fractures at the end of the implant, an area of relative mechanical stress. Post-operative femoral fractures are graded by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vancouver_classification\" title=\"Vancouver classification\" rel=\"external_link\" target=\"_blank\">Vancouver classification<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Vein_thrombosis\">Vein thrombosis<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Venous_thrombosis\" title=\"Venous thrombosis\" rel=\"external_link\" target=\"_blank\">Venous thrombosis<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Deep_vein_thrombosis\" title=\"Deep vein thrombosis\" rel=\"external_link\" target=\"_blank\">deep vein thrombosis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulmonary_embolism\" title=\"Pulmonary embolism\" rel=\"external_link\" target=\"_blank\">pulmonary embolism<\/a> are relatively common following hip replacement surgery. Standard treatment with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anticoagulant\" title=\"Anticoagulant\" rel=\"external_link\" target=\"_blank\">anticoagulants<\/a> is for 7\u201310 days; however treatment for more than 21 days may be superior.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> Research from 2013 has on the other hand suggested that anticoagulants in otherwise healthy patients undergoing a so-called fast track protocol with hospital stays under five days, might only be necessary while in the hospital.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p><p>Some physicians and patients may consider having an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasonography_for_deep_vein_thrombosis\" class=\"mw-redirect\" title=\"Ultrasonography for deep vein thrombosis\" rel=\"external_link\" target=\"_blank\">ultrasonography for deep vein thrombosis<\/a> after hip replacement.<sup id=\"rdp-ebb-cite_ref-AAOSfive_30-0\" class=\"reference\"><a href=\"#cite_note-AAOSfive-30\" rel=\"external_link\">[30]<\/a><\/sup> However, this kind of screening should only be done when indicated because to perform it routinely would be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Unnecessary_health_care\" title=\"Unnecessary health care\" rel=\"external_link\" target=\"_blank\">unnecessary health care<\/a>.<sup id=\"rdp-ebb-cite_ref-AAOSfive_30-1\" class=\"reference\"><a href=\"#cite_note-AAOSfive-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Osteolysis\">Osteolysis<\/span><\/h3>\n<p>Many long-term problems with hip replacements are the result of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteolysis\" title=\"Osteolysis\" rel=\"external_link\" target=\"_blank\">osteolysis<\/a>. This is the loss of bone caused by the body's reaction to polyethylene wear debris, fine bits of plastic that come off the cup liner over time. An <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\" title=\"Inflammation\" rel=\"external_link\" target=\"_blank\">inflammatory<\/a> process causes bone resorption that may lead to subsequent loosening of the hip implants and even fractures in the bone around the implants. In an attempt to eliminate the generation of wear particles, ceramic bearing surfaces are being used in the hope that they will have less wear and less osteolysis with better long-term results. Metal cup liners joined with metal heads (metal-on-metal hip arthroplasty) were also developed for similar reasons. In the lab these show excellent wear characteristics and benefit from a different mode of lubrication. At the same time that these two bearing surfaces were being developed, highly cross linked polyethylene plastic liners were also developed. The greater cross linking significantly reduces the amount of plastic wear debris given off over time. The newer ceramic and metal prostheses do not always have the long-term track record of established metal on poly bearings. Ceramic pieces can break leading to catastrophic failure. This occurs in about 2% of the implants placed. They may also cause an audible, high pitched squeaking noise with activity. Metal-on-metal arthroplasty releases metal debris into the body raising concerns about the potential dangers of these accumulating over time. Highly cross linked polyethylene is not as strong as regular polyethylene. These plastic liners can crack or break free of the metal shell that holds them.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Loosening\">Loosening<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_joint_aseptic_loosening_ar1938-1.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b7\/Hip_joint_aseptic_loosening_ar1938-1.png\/170px-Hip_joint_aseptic_loosening_ar1938-1.png\" width=\"170\" height=\"254\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_joint_aseptic_loosening_ar1938-1.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Hip prosthesis displaying aseptic loosening (arrows)<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:212px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_zones_by_DeLee_and_Charnley_system,_and_Gruen_system.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/Hip_prosthesis_zones_by_DeLee_and_Charnley_system%2C_and_Gruen_system.jpg\/210px-Hip_prosthesis_zones_by_DeLee_and_Charnley_system%2C_and_Gruen_system.jpg\" width=\"210\" height=\"215\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hip_prosthesis_zones_by_DeLee_and_Charnley_system,_and_Gruen_system.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_prosthesis_zones\" title=\"Hip prosthesis zones\" rel=\"external_link\" target=\"_blank\">Hip prosthesis zones<\/a> according to DeLee and Charnley,<sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> and Gruen.<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup> These are used to describe the location of for example areas of loosening.<\/div><\/div><\/div>\n<p>On radiography, it is normal to see thin radiolucent areas of less than 2 mm around hip prosthesis components, or between a cement mantle and bone. However, these may still indicate loosening of the prosthesis if they are new or changing, and areas greater than 2 mm may be harmless if they are stable.<sup id=\"rdp-ebb-cite_ref-RothMaertz2012_33-0\" class=\"reference\"><a href=\"#cite_note-RothMaertz2012-33\" rel=\"external_link\">[33]<\/a><\/sup> The most important prognostic factors of cemented cups are absence of radiolucent lines in DeLee and Charnley zone I, as well as adequate cement mantle thickness.<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup> In the first year after insertion of uncemented femoral stems, it is normal to have mild subsidence (less than 10 mm).<sup id=\"rdp-ebb-cite_ref-RothMaertz2012_33-1\" class=\"reference\"><a href=\"#cite_note-RothMaertz2012-33\" rel=\"external_link\">[33]<\/a><\/sup> The direct anterior approach has been shown to itself be a risk factor for early femoral component loosening.<sup id=\"rdp-ebb-cite_ref-James_I_2016_9-1\" class=\"reference\"><a href=\"#cite_note-James_I_2016-9\" rel=\"external_link\">[9]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Direct_Anterior_Approach_8-1\" class=\"reference\"><a href=\"#cite_note-Direct_Anterior_Approach-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Metal_sensitivity\">Metal sensitivity<\/span><\/h3>\n<p>Concerns are being raised about the metal sensitivity and potential dangers of metal particulate debris. New publications<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup> have demonstrated development of <i>pseudotumors<\/i>, soft tissue masses containing necrotic tissue, around the hip joint. It appears these masses are more common in women and these patients show a higher level of iron in the blood. The cause is unknown and is probably multifactorial. There may be a toxic reaction to an excess of particulate metal wear debris or a hypersensitivity reaction to a normal amount of metal debris.\n<\/p><p>Metal hypersensitivity is a well-established phenomenon and is common, affecting about 10\u201315% of the population.<sup id=\"rdp-ebb-cite_ref-Hallab01_38-0\" class=\"reference\"><a href=\"#cite_note-Hallab01-38\" rel=\"external_link\">[38]<\/a><\/sup> Contact with metals can cause immune reactions such as skin hives, eczema, redness and itching. Although little is known about the short- and long-term pharmacodynamics and bioavailability of circulating metal degradation products in vivo, there have been many reports of immunologic type responses temporally associated with implantation of metal components. Individual case reports link hypersensitivity immune reactions with adverse performance of metallic clinical cardiovascular, orthopedic and plastic surgical and dental implants.<sup id=\"rdp-ebb-cite_ref-Hallab01_38-1\" class=\"reference\"><a href=\"#cite_note-Hallab01-38\" rel=\"external_link\">[38]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Metal_toxicity\">Metal toxicity<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metallosis\" title=\"Metallosis\" rel=\"external_link\" target=\"_blank\">Metallosis<\/a><\/div>\n<p>Most hip replacements consist of cobalt and chromium alloys, or titanium. Stainless steel is no longer used. All implants release their constituent ions into the blood. Typically these are excreted in the urine, but in certain individuals the ions can accumulate in the body. In implants which involve metal-on-metal contact, microscopic fragments of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cobalt\" title=\"Cobalt\" rel=\"external_link\" target=\"_blank\">cobalt<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium\" title=\"Chromium\" rel=\"external_link\" target=\"_blank\">chromium<\/a> can be absorbed into the patient's bloodstream. There are reports of cobalt toxicity with hip replacement patients.<sup id=\"rdp-ebb-cite_ref-39\" class=\"reference\"><a href=\"#cite_note-39\" rel=\"external_link\">[39]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-reuters-20120329_40-0\" class=\"reference\"><a href=\"#cite_note-reuters-20120329-40\" rel=\"external_link\">[40]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Nerve_palsy\">Nerve palsy<\/span><\/h3>\n<p>Post operative sciatic nerve palsy is another possible complication. The incidence of this complication is low. Femoral nerve palsy is another but much more rare complication. Both of these will typically resolve over time, but the healing process is slow. Patients with pre-existing nerve injury are at greater risk of experiencing this complication and are also slower to recover.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Chronic_pain\">Chronic pain<\/span><\/h3>\n<p>A few patients who have had a hip replacement suffer chronic pain after the surgery. Groin pain can develop if the muscle that raises the hip (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Iliopsoas\" title=\"Iliopsoas\" rel=\"external_link\" target=\"_blank\">iliopsoas<\/a>) rubs against the edge of the acetabular cup. Bursitis can develop at the trochanter where a surgical scar crosses the bone, or if the femoral component used pushes the leg out to the side too far. Also some patients can experience pain in cold or damp weather.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2012)\">citation needed<\/span><\/a><\/i>]<\/sup> Incision made in the front of the hip (anterior approach) can cut a nerve running down the thigh leading to numbness in the thigh and occasionally chronic pain at the point where the nerve was cut (a neuroma).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Death\">Death<\/span><\/h3>\n<p>The rate of death for elective hip replacements is significantly less than 1%.<sup id=\"rdp-ebb-cite_ref-41\" class=\"reference\"><a href=\"#cite_note-41\" rel=\"external_link\">[41]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-42\" class=\"reference\"><a href=\"#cite_note-42\" rel=\"external_link\">[42]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Metal-on-metal_hip_implant_failure\">Metal-on-metal hip implant failure<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Implant_failure\" title=\"Implant failure\" rel=\"external_link\" target=\"_blank\">Implant failure<\/a><\/div>\n<p>By 2010, reports in the orthopaedic literature increasingly cited the problem of early failure of metal on metal prostheses in a small percentage of patients.<sup id=\"rdp-ebb-cite_ref-43\" class=\"reference\"><a href=\"#cite_note-43\" rel=\"external_link\">[43]<\/a><\/sup> Failures may relate to release of minute metallic particles or metal ions from wear of the implants, causing pain and disability severe enough to require revision surgery in 1\u20133% of patients.<sup id=\"rdp-ebb-cite_ref-44\" class=\"reference\"><a href=\"#cite_note-44\" rel=\"external_link\">[44]<\/a><\/sup> Design deficits of some prothesis models, especially with heat-treated alloys and a lack of special surgical experience accounting for most of the failures. In 2010, surgeons at medical centers such as the Mayo Clinic reported reducing their use of metal-on-metal implants by 80 percent over the previous year in favor of those made from other materials, like combinations of metal and plastic.<sup id=\"rdp-ebb-cite_ref-45\" class=\"reference\"><a href=\"#cite_note-45\" rel=\"external_link\">[45]<\/a><\/sup> The cause of these failures remain controversial, and may include both design factors, technique factors, and factors related to patient immune responses (allergy type reactions). In the United Kingdom the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicines_and_Healthcare_Products_Regulatory_Agency\" class=\"mw-redirect\" title=\"Medicines and Healthcare Products Regulatory Agency\" rel=\"external_link\" target=\"_blank\">Medicines and Healthcare Products Regulatory Agency<\/a> commenced an annual monitoring regime for metal-on-metal hip replacement patients from May 2010.<sup id=\"rdp-ebb-cite_ref-46\" class=\"reference\"><a href=\"#cite_note-46\" rel=\"external_link\">[46]<\/a><\/sup> Data which are shown in The Australian Orthopaedic Association's 2008 National <a href=\"https:\/\/en.wikipedia.org\/wiki\/Joint_replacement_registry\" title=\"Joint replacement registry\" rel=\"external_link\" target=\"_blank\">Joint replacement registry<\/a>, a record of nearly every hip implanted in that country over the previous 10 years, tracked 6,773 BHR (Birmingham Hip Resurfacing) Hips and found that less than one-third of one percent may have been revised due to the patient's reaction to the metal component.<sup id=\"rdp-ebb-cite_ref-47\" class=\"reference\"><a href=\"#cite_note-47\" rel=\"external_link\">[47]<\/a><\/sup> Other similar metal-on-metal designs have not fared as well, where some reports show 76% to 100% of the people with these metal-on-metal implants and have aseptic implant failures requiring revision also have evidence of histological inflammation accompanied by extensive lymphocyte infiltrates, characteristic of delayed type hypersensitivity responses.<sup id=\"rdp-ebb-cite_ref-48\" class=\"reference\"><a href=\"#cite_note-48\" rel=\"external_link\">[48]<\/a><\/sup> It is not clear to what extent this phenomenon negatively affects orthopedic patients. However, for patients presenting with signs of an allergic reactions, evaluation for sensitivity should be conducted. Removal of the device that is not needed should be considered, since removal may alleviate the symptoms. Patients who have allergic reactions to cheap jewelry are more likely to have reactions to orthopedic implants. There is increasing awareness of the phenomenon of metal sensitivity and many surgeons now take this into account when planning which implant is optimal for each patient.\n<\/p><p>On March 12, 2012, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Lancet\" title=\"The Lancet\" rel=\"external_link\" target=\"_blank\">The Lancet<\/a><\/i> published a study, based on data from the National Joint Registry of England and Wales, finding that metal-on-metal hip implants failed at much greater rates than other types of hip implants and calling for a ban on all metal-on-metal hips.<sup id=\"rdp-ebb-cite_ref-49\" class=\"reference\"><a href=\"#cite_note-49\" rel=\"external_link\">[49]<\/a><\/sup> The analysis of 402,051 hip replacements showed that 6.2% of metal-on-metal hip implants had failed within five years, compared to 1.7% of metal-on-plastic and 2.3% of ceramic-on-ceramic hip implants. Each 1 mm (0.039 in) increase in head size of metal-on-metal hip implants was associated with a 2% increase of failure.<sup id=\"rdp-ebb-cite_ref-50\" class=\"reference\"><a href=\"#cite_note-50\" rel=\"external_link\">[50]<\/a><\/sup> Surgeons of the British Hip Society are recommending that large head metal-on-metal implants should no longer be performed.<sup id=\"rdp-ebb-cite_ref-51\" class=\"reference\"><a href=\"#cite_note-51\" rel=\"external_link\">[51]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-52\" class=\"reference\"><a href=\"#cite_note-52\" rel=\"external_link\">[52]<\/a><\/sup>\n<\/p><p>On February 10, 2011, the U.S. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">FDA<\/a> issued an advisory on metal-metal hip implants, stating it was continuing to gather and review all available information about metal-on-metal hip systems.<sup id=\"rdp-ebb-cite_ref-53\" class=\"reference\"><a href=\"#cite_note-53\" rel=\"external_link\">[53]<\/a><\/sup> On June 27\u201328, 2012, an advisory panel met to decide whether to impose new standards, taking into account findings of the study in <i>The Lancet<\/i>.<sup id=\"rdp-ebb-cite_ref-reuters-20120329_40-1\" class=\"reference\"><a href=\"#cite_note-reuters-20120329-40\" rel=\"external_link\">[40]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-54\" class=\"reference\"><a href=\"#cite_note-54\" rel=\"external_link\">[54]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-FDA-summary-memo_55-0\" class=\"reference\"><a href=\"#cite_note-FDA-summary-memo-55\" rel=\"external_link\">[55]<\/a><\/sup> No new standards, such as routine checking of blood metal ion levels, were set, but guidance was updated.<sup id=\"rdp-ebb-cite_ref-56\" class=\"reference\"><a href=\"#cite_note-56\" rel=\"external_link\">[56]<\/a><\/sup> Currently, FDA has not required hip implants to be tested in clinical trials before they can be sold in the U.S.<sup id=\"rdp-ebb-cite_ref-57\" class=\"reference\"><a href=\"#cite_note-57\" rel=\"external_link\">[57]<\/a><\/sup> Instead, companies making new hip implants only need to prove that they are \"substantially equivalent\" to other hip implants already on the market. The exception is metal-on-metal implants, which were not tested in clinical trials but because of the high revision rate of metal-on-metal hips, in the future the FDA has stated that clinical trials will be required for approval and that post-market studies will be required to keep metal on metal hip implants on the market.<sup id=\"rdp-ebb-cite_ref-58\" class=\"reference\"><a href=\"#cite_note-58\" rel=\"external_link\">[58]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Alternatives_and_variations\">Alternatives and variations<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Conservative_management\">Conservative management<\/span><\/h3>\n<p>The first line approach as an alternative to hip replacement is conservative management which involves a multimodal approach of oral medication, injections, activity modification and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_therapy\" title=\"Physical therapy\" rel=\"external_link\" target=\"_blank\">physical therapy<\/a>.<sup id=\"rdp-ebb-cite_ref-59\" class=\"reference\"><a href=\"#cite_note-59\" rel=\"external_link\">[59]<\/a><\/sup> Conservative management can prevent or delay the need for hip replacement.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Preoperative_care\">Preoperative care<\/span><\/h3>\n<p>Preoperative education is currently an important part of patient care. There is some evidence that it may slightly reduce anxiety before hip or knee replacement, with low risk of negative effects.<sup id=\"rdp-ebb-cite_ref-60\" class=\"reference\"><a href=\"#cite_note-60\" rel=\"external_link\">[60]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hemiarthroplasty\">Hemiarthroplasty<\/span><\/h3>\n<p><b>Hemiarthroplasty<\/b> is a surgical procedure which replaces one half of the joint with an artificial surface and leaves the other part in its natural (pre-operative) state. This class of procedure is most commonly performed on the hip after a subcapital (just below the head) fracture of the neck of the femur (a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_fracture\" title=\"Hip fracture\" rel=\"external_link\" target=\"_blank\">hip fracture<\/a>). The procedure is performed by removing the head of the femur and replacing it with a metal or composite <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prosthesis\" title=\"Prosthesis\" rel=\"external_link\" target=\"_blank\">prosthesis<\/a>. The most commonly used prosthesis designs are the Austin Moore prosthesis and the Thompson Prosthesis. More recently a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Composite_material\" title=\"Composite material\" rel=\"external_link\" target=\"_blank\">composite<\/a> of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metal\" title=\"Metal\" rel=\"external_link\" target=\"_blank\">metal<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/HDPE\" class=\"mw-redirect\" title=\"HDPE\" rel=\"external_link\" target=\"_blank\">HDPE<\/a> which forms two interphases (bipolar prosthesis) has also been used. The monopolar prosthesis has not been shown to have any advantage over bipolar designs. The procedure is recommended only for elderly and frail patients, due to their lower life expectancy and activity level. This is because with the passage of time the prosthesis tends to loosen or to erode the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetabulum\" title=\"Acetabulum\" rel=\"external_link\" target=\"_blank\">acetabulum<\/a>.<sup id=\"rdp-ebb-cite_ref-61\" class=\"reference\"><a href=\"#cite_note-61\" rel=\"external_link\">[61]<\/a><\/sup>\n<\/p>\n<ul class=\"gallery mw-gallery-packed\">\n\t\t<li class=\"gallerybox\" style=\"width: 242.66666666667px\"><div style=\"width: 242.66666666667px\">\n\t\t\t<div class=\"thumb\" style=\"width: 240.66666666667px;\"><div style=\"margin:0px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bipolar_hip_prosthesis.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/47\/Bipolar_hip_prosthesis.jpg\/361px-Bipolar_hip_prosthesis.jpg\" width=\"241\" height=\"160\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Hip prosthesis for hemiarthroplasty. This example is bipolar, meaning that the head has 2 separate articulations.\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 215.33333333333px\"><div style=\"width: 215.33333333333px\">\n\t\t\t<div class=\"thumb\" style=\"width: 213.33333333333px;\"><div style=\"margin:0px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:X-ray_of_hips_with_a_hemiarthroplasty.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/X-ray_of_hips_with_a_hemiarthroplasty.jpg\/320px-X-ray_of_hips_with_a_hemiarthroplasty.jpg\" width=\"214\" height=\"160\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Projectional_radiography\" title=\"Projectional radiography\" rel=\"external_link\" target=\"_blank\">X-ray<\/a> of the hips, with a right-sided hemiarthroplasty.\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 265.33333333333px\"><div style=\"width: 265.33333333333px\">\n\t\t\t<div class=\"thumb\" style=\"width: 263.33333333333px;\"><div style=\"margin:0px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Femoral_offset_in_hemiarthroplasty.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/Femoral_offset_in_hemiarthroplasty.jpg\/395px-Femoral_offset_in_hemiarthroplasty.jpg\" width=\"264\" height=\"160\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Femoral (neck) offset is defined as the perpendicular distance between the intramedullary or longitudinal axis of the femur and the center of rotation of the native or prosthetic femoral head. An unnatural offset is associated with hip dislocation.<sup id=\"rdp-ebb-cite_ref-JonesBriffa2017_62-0\" class=\"reference\"><a href=\"#cite_note-JonesBriffa2017-62\" rel=\"external_link\">[62]<\/a><\/sup>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h3><span class=\"mw-headline\" id=\"Hip_resurfacing\">Hip resurfacing<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_resurfacing\" title=\"Hip resurfacing\" rel=\"external_link\" target=\"_blank\">Hip resurfacing<\/a> is an alternative to hip replacement surgery. It has been used in Europe for over seventeen years and become a common procedure. Health-related quality of life measures are markedly improved and patient satisfaction is favorable after hip resurfacing arthroplasty.<sup id=\"rdp-ebb-cite_ref-63\" class=\"reference\"><a href=\"#cite_note-63\" rel=\"external_link\">[63]<\/a><\/sup>\n<\/p><p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive_hip_resurfacing\" title=\"Minimally invasive hip resurfacing\" rel=\"external_link\" target=\"_blank\">minimally invasive hip resurfacing<\/a> procedure is a further refinement to hip resurfacing.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Viscosupplementation\">Viscosupplementation<\/span><\/h3>\n<p>Current alternatives also include viscosupplementation, or the injection of artificial lubricants into the joint.<sup id=\"rdp-ebb-cite_ref-pmid17874246_64-0\" class=\"reference\"><a href=\"#cite_note-pmid17874246-64\" rel=\"external_link\">[64]<\/a><\/sup> Use of these medications in the hip is off label. The cost of treatment is typically not covered by health insurance organizations.\n<\/p><p>Some believe that the future of osteoarthritis treatment is <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bioengineering\" class=\"mw-redirect\" title=\"Bioengineering\" rel=\"external_link\" target=\"_blank\">bioengineering<\/a>, targeting the growth and\/or repair of the damaged, arthritic joint. Centeno et al. have reported on the partial regeneration of an arthritic human hip joint using mesenchymal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stem_cell\" title=\"Stem cell\" rel=\"external_link\" target=\"_blank\">stem cells<\/a> in one patient.<sup id=\"rdp-ebb-cite_ref-pmid16886034_65-0\" class=\"reference\"><a href=\"#cite_note-pmid16886034-65\" rel=\"external_link\">[65]<\/a><\/sup> It is yet to be shown that this result will apply to a larger group of patients and result in significant benefits. The FDA has stated that this procedure is being practiced without conforming to regulations, but Centeno claims that it is exempt from FDA regulation. It has not been shown in controlled clinical trials to be effective<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2014)\">citation needed<\/span><\/a><\/i>]<\/sup>, and costs over $7,000.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Prevalence_and_cost\">Prevalence and cost<\/span><\/h2>\n<p>Total hip replacement incidence varies in developed countries between 30 (Romania) and 290 (Germany) procedures per 100,000 population per year.<sup id=\"rdp-ebb-cite_ref-66\" class=\"reference\"><a href=\"#cite_note-66\" rel=\"external_link\">[66]<\/a><\/sup> Approximately 0.8% of Americans have undergone the procedure.<sup id=\"rdp-ebb-cite_ref-67\" class=\"reference\"><a href=\"#cite_note-67\" rel=\"external_link\">[67]<\/a><\/sup>\n<\/p><p>According to the International Federation of Healthcare Plans, the average cost of a total hip replacement in 2012 was $40,364 in the United States, $11,889 in the United Kingdom, $10,987 in France, $9,574 in Switzerland, and $7,731 in Spain.<sup id=\"rdp-ebb-cite_ref-ifhp_1-1\" class=\"reference\"><a href=\"#cite_note-ifhp-1\" rel=\"external_link\">[1]<\/a><\/sup> In the United States, the average cost of a total hip replacement varies widely by geographic region, ranging from $11,327 (Birmingham, Alabama) to $73,927 (Boston, Massachusetts).<sup id=\"rdp-ebb-cite_ref-68\" class=\"reference\"><a href=\"#cite_note-68\" rel=\"external_link\">[68]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The earliest recorded attempts at hip replacement were carried out in Germany in 1891 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Themistocles_Gluck\" title=\"Themistocles Gluck\" rel=\"external_link\" target=\"_blank\">Themistocles Gluck<\/a> (1853\u20131942),<sup id=\"rdp-ebb-cite_ref-69\" class=\"reference\"><a href=\"#cite_note-69\" rel=\"external_link\">[69]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-70\" class=\"reference\"><a href=\"#cite_note-70\" rel=\"external_link\">[70]<\/a><\/sup> who used ivory to replace the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Femoral_head\" title=\"Femoral head\" rel=\"external_link\" target=\"_blank\">femoral head<\/a> (the ball on the femur), attaching it with nickel-plated screws, Plaster of Paris, and glue.<sup id=\"rdp-ebb-cite_ref-pmid16089067_71-0\" class=\"reference\"><a href=\"#cite_note-pmid16089067-71\" rel=\"external_link\">[71]<\/a><\/sup>\n<\/p><p>On September 28, 1940 at Columbia Hospital in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Columbia,_South_Carolina\" title=\"Columbia, South Carolina\" rel=\"external_link\" target=\"_blank\">Columbia, South Carolina<\/a>, American surgeon Dr. Austin T. Moore (1899\u20131963)<sup id=\"rdp-ebb-cite_ref-72\" class=\"reference\"><a href=\"#cite_note-72\" rel=\"external_link\">[72]<\/a><\/sup> performed the first metallic hip replacement surgery. The original prosthesis he designed was a proximal femoral replacement, with a large fixed head made of the cobalt-chrome alloy <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vitallium\" title=\"Vitallium\" rel=\"external_link\" target=\"_blank\">Vitallium<\/a>. It was about a foot in length and bolted to the resected end of the femoral shaft (hemiarthroplasty). A later version, the so-called Austin Moore Prosthesis which was introduced in 1952, is still in use today, although rarely. Like modern hip implants, it is inserted into the medullary canal of the femur, and depends on bone growth through a hole in the stem for long-term attachment.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Abductor_wedge\" title=\"Abductor wedge\" rel=\"external_link\" target=\"_blank\">Abductor wedge<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Femoral_Acetabular_Impingement\" class=\"mw-redirect\" title=\"Femoral Acetabular Impingement\" rel=\"external_link\" target=\"_blank\">Femoral Acetabular Impingement<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gruen_zone\" class=\"mw-redirect\" title=\"Gruen zone\" rel=\"external_link\" target=\"_blank\">Gruen zone<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_examination\" title=\"Hip examination\" rel=\"external_link\" target=\"_blank\">Hip examination<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/2010_DePuy_Hip_Recall\" title=\"2010 DePuy Hip Recall\" rel=\"external_link\" target=\"_blank\">2010 DePuy Hip Recall<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-ifhp-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ifhp_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ifhp_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/hushp.harvard.edu\/sites\/default\/files\/downloadable_files\/IFHP%202012%20Comparative%20Price%20Report.pdf\" target=\"_blank\">\"2012 comparative price report\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. International Federation of Health Plans<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">4 October<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=2012+comparative+price+report&rft.pub=International+Federation+of+Health+Plans&rft_id=http%3A%2F%2Fhushp.harvard.edu%2Fsites%2Fdefault%2Ffiles%2Fdownloadable_files%2FIFHP%25202012%2520Comparative%2520Price%2520Report.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Andrew Still (2002-11-02). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/illumin.usc.edu\/61\/total-hip-replacement\/\" target=\"_blank\">\"Total Hip Replacement\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Southern_California\" title=\"University of Southern California\" rel=\"external_link\" target=\"_blank\">University of Southern California<\/a><\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-01-05<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=University+of+Southern+California&rft.atitle=Total+Hip+Replacement&rft.date=2002-11-02&rft.au=Andrew+Still&rft_id=http%3A%2F%2Fillumin.usc.edu%2F61%2Ftotal-hip-replacement%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Timperley, A John (20 October 2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.theguardian.com\/science\/2017\/oct\/20\/robin-ling-obituary\" target=\"_blank\">\"Robin Ling obituary\"<\/a>. <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Guardian\" title=\"The Guardian\" rel=\"external_link\" target=\"_blank\">The Guardian<\/a><\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">22 October<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Guardian&rft.atitle=Robin+Ling+obituary&rft.date=2017-10-20&rft.aulast=Timperley&rft.aufirst=A+John&rft_id=https%3A%2F%2Fwww.theguardian.com%2Fscience%2F2017%2Foct%2F20%2Frobin-ling-obituary&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid9498150-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid9498150_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pai VS (1997). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20020108155635\/http:\/\/www.link.springer.de\/link\/service\/journals\/00264\/bibs\/8021006\/80210393.htm\" target=\"_blank\">\"A comparison of three lateral approaches in primary total hip replacement\"<\/a>. <i>Int Orthop<\/i>. <b>21<\/b> (6): 393\u2013398. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs002640050193\" target=\"_blank\">10.1007\/s002640050193<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3619565\" target=\"_blank\">3619565<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9498150\" target=\"_blank\">9498150<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/link.springer.de\/link\/service\/journals\/00264\/bibs\/8021006\/80210393.htm\" target=\"_blank\">the original<\/a> on 2002-01-08.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Int+Orthop&rft.atitle=A+comparison+of+three+lateral+approaches+in+primary+total+hip+replacement&rft.volume=21&rft.issue=6&rft.pages=393-398&rft.date=1997&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3619565&rft_id=info%3Apmid%2F9498150&rft_id=info%3Adoi%2F10.1007%2Fs002640050193&rft.au=Pai+VS&rft_id=http%3A%2F%2Flink.springer.de%2Flink%2Fservice%2Fjournals%2F00264%2Fbibs%2F8021006%2F80210393.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-titleAnterolateral_Approach_to_Hip_Joint:_(Watson_Jones)_-_Wheeless'_Textbook_of_Orthopaedics-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#39;_Textbook_of_Orthopaedics_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.wheelessonline.com\/ortho\/anterolateral_approach_to_hip_joint_watson_jones\" target=\"_blank\">\"Anterolateral Approach to Hip Joint: (Watson Jones) \u2013 Wheeless' Textbook of Orthopaedics\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2007-11-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Anterolateral+Approach+to+Hip+Joint%3A+%28Watson+Jones%29+%E2%80%93+Wheeless%27+Textbook+of+Orthopaedics&rft_id=http%3A%2F%2Fwww.wheelessonline.com%2Fortho%2Fanterolateral_approach_to_hip_joint_watson_jones&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-titleAnterior_Approach_to_the_Hip_(Smith_Petersen)_-_Wheeless'_Textbook_of_Orthopaedics-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#39;_Textbook_of_Orthopaedics_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.wheelessonline.com\/ortho\/anterior_approach_to_the_hip_smith_peterson\" target=\"_blank\">\"Anterior Approach to the Hip (Smith Petersen) \u2013 Wheeless' Textbook of Orthopaedics\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2007-11-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Anterior+Approach+to+the+Hip+%28Smith+Petersen%29+%E2%80%93+Wheeless%27+Textbook+of+Orthopaedics&rft_id=http%3A%2F%2Fwww.wheelessonline.com%2Fortho%2Fanterior_approach_to_the_hip_smith_peterson&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Maratt, Joseph D.; Gagnier, Joel J.; Butler, Paul D.; Hallstrom, Brian R.; Urquhart, Andrew G.; Roberts, Karl C. (September 2016). \"No Difference in Dislocation Seen in Anterior Vs Posterior Approach Total Hip Arthroplasty\". <i>The Journal of Arthroplasty<\/i>. <b>31<\/b> (9): 127\u2013130. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2016.02.071\" target=\"_blank\">10.1016\/j.arth.2016.02.071<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=No+Difference+in+Dislocation+Seen+in+Anterior+Vs+Posterior+Approach+Total+Hip+Arthroplasty&rft.volume=31&rft.issue=9&rft.pages=127-130&rft.date=2016-09&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2016.02.071&rft.aulast=Maratt&rft.aufirst=Joseph+D.&rft.au=Gagnier%2C+Joel+J.&rft.au=Butler%2C+Paul+D.&rft.au=Hallstrom%2C+Brian+R.&rft.au=Urquhart%2C+Andrew+G.&rft.au=Roberts%2C+Karl+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Direct_Anterior_Approach-8\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Direct_Anterior_Approach_8-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Direct_Anterior_Approach_8-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Meneghini, R. Michael; Elston, Addison S.; Chen, Antonia F.; Kheir, Michael M.; Fehring, Thomas K.; Springer, Bryan D. (January 2017). \"Direct Anterior Approach\". <i>The Journal of Bone and Joint Surgery<\/i>. <b>99<\/b> (2): 99\u2013105. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.16.00060\" target=\"_blank\">10.2106\/JBJS.16.00060<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28099299\" target=\"_blank\">28099299<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Bone+and+Joint+Surgery&rft.atitle=Direct+Anterior+Approach&rft.volume=99&rft.issue=2&rft.pages=99-105&rft.date=2017-01&rft_id=info%3Adoi%2F10.2106%2FJBJS.16.00060&rft_id=info%3Apmid%2F28099299&rft.aulast=Meneghini&rft.aufirst=R.+Michael&rft.au=Elston%2C+Addison+S.&rft.au=Chen%2C+Antonia+F.&rft.au=Kheir%2C+Michael+M.&rft.au=Fehring%2C+Thomas+K.&rft.au=Springer%2C+Bryan+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-James_I_2016-9\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-James_I_2016_9-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-James_I_2016_9-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Eto, Shuichi; Hwang, Katherine; Huddleston, James I.; Amanatullah, Derek F.; Maloney, William J.; Goodman, Stuart B. 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Retrieved <span class=\"nowrap\">2017-05-21<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Radiology+Assistant&rft.atitle=Hip+-+Arthroplasty+-Normal+and+abnormal+imaging+findings&rft.au=Iain+Watt%2C+Susanne+Boldrik%2C+Evert+van+Langelaan+and+Robin+Smithuis&rft_id=http%3A%2F%2Fwww.radiologyassistant.nl%2Fen%2Fp431c8258e7ac3%2Fhip-arthroplasty.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Vanrusselt2015-19\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Vanrusselt2015_19-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Vanrusselt2015_19-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Vanrusselt2015_19-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Vanrusselt2015_19-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Vanrusselt2015_19-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Vanrusselt2015_19-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Vanrusselt2015_19-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Vanrusselt2015_19-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vanrusselt, Jan; Vansevenant, Milan; Vanderschueren, Geert; Vanhoenacker, Filip (2015). \"Postoperative radiograph of the hip arthroplasty: what the radiologist should know\". <i>Insights into Imaging<\/i>. <b>6<\/b> (6): 591\u2013600. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs13244-015-0438-5\" target=\"_blank\">10.1007\/s13244-015-0438-5<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1869-4101\" target=\"_blank\">1869-4101<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26487647\" target=\"_blank\">26487647<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Insights+into+Imaging&rft.atitle=Postoperative+radiograph+of+the+hip+arthroplasty%3A+what+the+radiologist+should+know&rft.volume=6&rft.issue=6&rft.pages=591-600&rft.date=2015&rft.issn=1869-4101&rft_id=info%3Apmid%2F26487647&rft_id=info%3Adoi%2F10.1007%2Fs13244-015-0438-5&rft.aulast=Vanrusselt&rft.aufirst=Jan&rft.au=Vansevenant%2C+Milan&rft.au=Vanderschueren%2C+Geert&rft.au=Vanhoenacker%2C+Filip&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-ShinLee2015-20\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ShinLee2015_20-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ShinLee2015_20-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Shin, W. 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Systematic review and meta-analysis\". <i>The Bone & Joint Journal<\/i>. <b>98-B<\/b> (9): 1160\u20131166. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1302%2F0301-620x.98b9.38024\" target=\"_blank\">10.1302\/0301-620x.98b9.38024<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27587514\" target=\"_blank\">27587514<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Bone+%26+Joint+Journal&rft.atitle=Does+bariatric+surgery+prior+to+total+hip+or+knee+arthroplasty+reduce+post-operative+complications+and+improve+clinical+outcomes+for+obese+patients%3F+Systematic+review+and+meta-analysis.&rft.volume=98-B&rft.issue=9&rft.pages=1160-1166&rft.date=2016-09&rft_id=info%3Adoi%2F10.1302%2F0301-620x.98b9.38024&rft_id=info%3Apmid%2F27587514&rft.aulast=Smith&rft.aufirst=TO&rft.au=Aboelmagd%2C+T&rft.au=Hing%2C+CB&rft.au=MacGregor%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bozic, Kevin J; Kurtz, Steven M; Lau, Edmund; Ong, Kevin; Vail, Thomas P; Berry, Daniel J (January 2009). \"The Epidemiology of Revision Total Hip Arthroplasty in the United States\". <i>The Journal of Bone and Joint Surgery. American Volume<\/i>. <b>91<\/b> (1): 128\u2013133. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.H.00155\" target=\"_blank\">10.2106\/JBJS.H.00155<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Bone+and+Joint+Surgery.+American+Volume&rft.atitle=The+Epidemiology+of+Revision+Total+Hip+Arthroplasty+in+the+United+States&rft.volume=91&rft.issue=1&rft.pages=128-133&rft.date=2009-01&rft_id=info%3Adoi%2F10.2106%2FJBJS.H.00155&rft.aulast=Bozic&rft.aufirst=Kevin+J&rft.au=Kurtz%2C+Steven+M&rft.au=Lau%2C+Edmund&rft.au=Ong%2C+Kevin&rft.au=Vail%2C+Thomas+P&rft.au=Berry%2C+Daniel+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Parvizi, Javad; Zmistowski, Benjamin; Berbari, Elie F.; Bauer, Thomas W.; Springer, Bryan D.; Della Valle, Craig J.; Garvin, Kevin L.; Mont, Michael A.; Wongworawat, Montri D.; Zalavras, Charalampos G. (22 September 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3183178\" target=\"_blank\">\"New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society\"<\/a>. <i>Clinical Orthopaedics and Related Research<\/i>. <b>469<\/b> (11): 2992\u20132994. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11999-011-2102-9\" target=\"_blank\">10.1007\/s11999-011-2102-9<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3183178\" target=\"_blank\">3183178<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Orthopaedics+and+Related+Research&rft.atitle=New+Definition+for+Periprosthetic+Joint+Infection%3A+From+the+Workgroup+of+the+Musculoskeletal+Infection+Society&rft.volume=469&rft.issue=11&rft.pages=2992-2994&rft.date=2011-09-22&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3183178&rft_id=info%3Adoi%2F10.1007%2Fs11999-011-2102-9&rft.aulast=Parvizi&rft.aufirst=Javad&rft.au=Zmistowski%2C+Benjamin&rft.au=Berbari%2C+Elie+F.&rft.au=Bauer%2C+Thomas+W.&rft.au=Springer%2C+Bryan+D.&rft.au=Della+Valle%2C+Craig+J.&rft.au=Garvin%2C+Kevin+L.&rft.au=Mont%2C+Michael+A.&rft.au=Wongworawat%2C+Montri+D.&rft.au=Zalavras%2C+Charalampos+G.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3183178&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-berry2012-24\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-berry2012_24-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-berry2012_24-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-berry2012_24-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-berry2012_24-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Daniel J. Berry, Jay Lieberman (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.se\/books?id=Kc-AhYLnIF4C&pg=PA1035\" target=\"_blank\"><i>Surgery of the Hip<\/i><\/a>. Elsevier Health Sciences. p. 1035. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9781455727056.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Surgery+of+the+Hip&rft.pages=1035&rft.pub=Elsevier+Health+Sciences&rft.date=2012&rft.isbn=9781455727056&rft.au=Daniel+J.+Berry%2C+Jay+Lieberman&rft_id=https%3A%2F%2Fbooks.google.se%2Fbooks%3Fid%3DKc-AhYLnIF4C%26pg%3DPA1035&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hailer, Nils P.; Weiss, R\u00fcdiger J.; Stark, Andr\u00e9; K\u00e4rrholm, Johan (October 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3488169\" target=\"_blank\">\"The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. An analysis of 78,098 operations in the Swedish Hip Arthroplasty Register\"<\/a>. <i>Acta Orthopaedica<\/i>. <b>83<\/b> (5): 442\u2013448. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3109%2F17453674.2012.733919\" target=\"_blank\">10.3109\/17453674.2012.733919<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1745-3682\" target=\"_blank\">1745-3682<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3488169\" target=\"_blank\">3488169<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23039167\" target=\"_blank\">23039167<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Orthopaedica&rft.atitle=The+risk+of+revision+due+to+dislocation+after+total+hip+arthroplasty+depends+on+surgical+approach%2C+femoral+head+size%2C+sex%2C+and+primary+diagnosis.+An+analysis+of+78%2C098+operations+in+the+Swedish+Hip+Arthroplasty+Register&rft.volume=83&rft.issue=5&rft.pages=442-448&rft.date=2012-10&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3488169&rft.issn=1745-3682&rft_id=info%3Apmid%2F23039167&rft_id=info%3Adoi%2F10.3109%2F17453674.2012.733919&rft.aulast=Hailer&rft.aufirst=Nils+P.&rft.au=Weiss%2C+R%C3%BCdiger+J.&rft.au=Stark%2C+Andr%C3%A9&rft.au=K%C3%A4rrholm%2C+Johan&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3488169&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Knutson, Gary A (2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1232860\" target=\"_blank\">\"Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance\"<\/a>. <i>Chiropractic & Osteopathy<\/i>. <b>13<\/b> (1): 11. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2F1746-1340-13-11\" target=\"_blank\">10.1186\/1746-1340-13-11<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1232860\" target=\"_blank\">1232860<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Chiropractic+%26+Osteopathy&rft.atitle=Anatomic+and+functional+leg-length+inequality%3A+A+review+and+recommendation+for+clinical+decision-making.+Part+I%2C+anatomic+leg-length+inequality%3A+prevalence%2C+magnitude%2C+effects+and+clinical+significance&rft.volume=13&rft.issue=1&rft.pages=11&rft.date=2005&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1232860&rft_id=info%3Adoi%2F10.1186%2F1746-1340-13-11&rft.aulast=Knutson&rft.aufirst=Gary+A&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1232860&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Maloney, William J; Keeney, James A (June 2004). \"Leg length discrepancy after total hip arthroplasty\". <i>The Journal of Arthroplasty<\/i>. <b>19<\/b> (4): 108\u2013110. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2004.02.018\" target=\"_blank\">10.1016\/j.arth.2004.02.018<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=Leg+length+discrepancy+after+total+hip+arthroplasty&rft.volume=19&rft.issue=4&rft.pages=108-110&rft.date=2004-06&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2004.02.018&rft.aulast=Maloney&rft.aufirst=William+J&rft.au=Keeney%2C+James+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sobieraj, DM; Lee, S; Coleman, CI; Tongbram, V; Chen, W; Colby, J; Kluger, J; Makanji, S; Ashaye, AO; White, CM (May 15, 2012). \"Prolonged versus standard-duration venous thromboprophylaxis in major orthopedic surgery: a systematic review\". <i>Annals of Internal Medicine<\/i>. <b>156<\/b> (10): 720\u20137. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.7326%2F0003-4819-156-10-201205150-00423\" target=\"_blank\">10.7326\/0003-4819-156-10-201205150-00423<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22412039\" target=\"_blank\">22412039<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Internal+Medicine&rft.atitle=Prolonged+versus+standard-duration+venous+thromboprophylaxis+in+major+orthopedic+surgery%3A+a+systematic+review&rft.volume=156&rft.issue=10&rft.pages=720-7&rft.date=2012-05-15&rft_id=info%3Adoi%2F10.7326%2F0003-4819-156-10-201205150-00423&rft_id=info%3Apmid%2F22412039&rft.aulast=Sobieraj&rft.aufirst=DM&rft.au=Lee%2C+S&rft.au=Coleman%2C+CI&rft.au=Tongbram%2C+V&rft.au=Chen%2C+W&rft.au=Colby%2C+J&rft.au=Kluger%2C+J&rft.au=Makanji%2C+S&rft.au=Ashaye%2C+AO&rft.au=White%2C+CM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">J\u00f8rgensen, Christoffer C.; Jacobsen, Michael K.; Soeballe, Kjeld; Hansen, Torben B.; Husted, Henrik; Kj\u00e6rsgaard-Andersen, Per; Hansen, Lars T.; Laursen, Mogens B.; Kehlet, Henrik (2013). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3863129\" target=\"_blank\">\"Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study\"<\/a>. <i>BMJ Open<\/i>. <b>3<\/b> (12): e003965. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmjopen-2013-003965\" target=\"_blank\">10.1136\/bmjopen-2013-003965<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/2044-6055\" target=\"_blank\">2044-6055<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3863129\" target=\"_blank\">3863129<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24334158\" target=\"_blank\">24334158<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMJ+Open&rft.atitle=Thromboprophylaxis+only+during+hospitalisation+in+fast-track+hip+and+knee+arthroplasty%2C+a+prospective+cohort+study&rft.volume=3&rft.issue=12&rft.pages=e003965&rft.date=2013&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3863129&rft.issn=2044-6055&rft_id=info%3Apmid%2F24334158&rft_id=info%3Adoi%2F10.1136%2Fbmjopen-2013-003965&rft.aulast=J%C3%B8rgensen&rft.aufirst=Christoffer+C.&rft.au=Jacobsen%2C+Michael+K.&rft.au=Soeballe%2C+Kjeld&rft.au=Hansen%2C+Torben+B.&rft.au=Husted%2C+Henrik&rft.au=Kj%C3%A6rsgaard-Andersen%2C+Per&rft.au=Hansen%2C+Lars+T.&rft.au=Laursen%2C+Mogens+B.&rft.au=Kehlet%2C+Henrik&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3863129&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-AAOSfive-30\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-AAOSfive_30-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-AAOSfive_30-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFAmerican_Academy_of_Orthopaedic_Surgeons2013\" class=\"citation\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Academy_of_Orthopaedic_Surgeons\" title=\"American Academy of Orthopaedic Surgeons\" rel=\"external_link\" target=\"_blank\">American Academy of Orthopaedic Surgeons<\/a> (February 2013), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.choosingwisely.org\/doctor-patient-lists\/american-academy-of-orthopaedic-surgeons\/\" target=\"_blank\">\"Five Things Physicians and Patients Should Question\"<\/a>, <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Choosing_Wisely\" title=\"Choosing Wisely\" rel=\"external_link\" target=\"_blank\">Choosing Wisely<\/a>: an initiative of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ABIM_Foundation\" class=\"mw-redirect\" title=\"ABIM Foundation\" rel=\"external_link\" target=\"_blank\">ABIM Foundation<\/a><\/i>, American Academy of Orthopaedic Surgeons<span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">19 May<\/span> 2013<\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Choosing+Wisely%3A+an+initiative+of+the+ABIM+Foundation&rft.atitle=Five+Things+Physicians+and+Patients+Should+Question&rft.date=2013-02&rft.au=American+Academy+of+Orthopaedic+Surgeons&rft_id=http%3A%2F%2Fwww.choosingwisely.org%2Fdoctor-patient-lists%2Famerican-academy-of-orthopaedic-surgeons%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>, which cites\n<ul><li><cite class=\"citation journal\">Members of 2007 and 2011 AAOS Guideline Development Work Groups on PE\/VTED Prophylaxis; Mont, M; Jacobs, J; Lieberman, J; Parvizi, J; Lachiewicz, P; Johanson, N; Watters, W (Apr 18, 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3326687\" target=\"_blank\">\"Preventing venous thromboembolic disease in patients undergoing elective total hip and knee arthroplasty\"<\/a>. <i>The Journal of Bone and Joint Surgery. American Volume<\/i>. <b>94<\/b> (8): 673\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.9408edit\" target=\"_blank\">10.2106\/JBJS.9408edit<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3326687\" target=\"_blank\">3326687<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22517384\" target=\"_blank\">22517384<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Bone+and+Joint+Surgery.+American+Volume&rft.atitle=Preventing+venous+thromboembolic+disease+in+patients+undergoing+elective+total+hip+and+knee+arthroplasty.&rft.volume=94&rft.issue=8&rft.pages=673-4&rft.date=2012-04-18&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3326687&rft_id=info%3Apmid%2F22517384&rft_id=info%3Adoi%2F10.2106%2FJBJS.9408edit&rft.au=Members+of+2007+and+2011+AAOS+Guideline+Development+Work+Groups+on+PE%2FVTED+Prophylaxis&rft.au=Mont%2C+M&rft.au=Jacobs%2C+J&rft.au=Lieberman%2C+J&rft.au=Parvizi%2C+J&rft.au=Lachiewicz%2C+P&rft.au=Johanson%2C+N&rft.au=Watters%2C+W&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3326687&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<\/span><\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">John J. Callaghan, Aaron G. Rosenberg, Harry E. Rubash (2007). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=-fwULYB1gJIC&pg=PA958\" target=\"_blank\"><i>The Adult Hip, Volume 1<\/i><\/a>. Lippincott Williams & Wilkins. p. 958. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-7817-5092-9.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Adult+Hip%2C+Volume+1&rft.pages=958&rft.pub=Lippincott+Williams+%26+Wilkins&rft.date=2007&rft.isbn=978-0-7817-5092-9&rft.au=John+J.+Callaghan%2C+Aaron+G.+Rosenberg%2C+Harry+E.+Rubash&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D-fwULYB1gJIC%26pg%3DPA958&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Multiple names: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Multiple_names:_authors_list\" title=\"Category:CS1 maint: Multiple names: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Neumann, Daniel R.P.; Thaler, Christoph; Hitzl, Wolfgang; Huber, Monika; Hofst\u00e4dter, Thomas; Dorn, Ulrich (2010). \"Long-Term Results of a Contemporary Metal-on-Metal Total Hip Arthroplasty\". <i>The Journal of Arthroplasty<\/i>. <b>25<\/b> (5): 700\u2013708. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2009.05.018\" target=\"_blank\">10.1016\/j.arth.2009.05.018<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0883-5403\" target=\"_blank\">0883-5403<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=Long-Term+Results+of+a+Contemporary+Metal-on-Metal+Total+Hip+Arthroplasty&rft.volume=25&rft.issue=5&rft.pages=700-708&rft.date=2010&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2009.05.018&rft.issn=0883-5403&rft.aulast=Neumann&rft.aufirst=Daniel+R.P.&rft.au=Thaler%2C+Christoph&rft.au=Hitzl%2C+Wolfgang&rft.au=Huber%2C+Monika&rft.au=Hofst%C3%A4dter%2C+Thomas&rft.au=Dorn%2C+Ulrich&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-RothMaertz2012-33\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-RothMaertz2012_33-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-RothMaertz2012_33-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Roth, Trenton D.; Maertz, Nathan A.; Parr, J. Andrew; Buckwalter, Kenneth A.; Choplin, Robert H. (2012). \"CT of the Hip Prosthesis: Appearance of Components, Fixation, and Complications\". <i>RadioGraphics<\/i>. <b>32<\/b> (4): 1089\u20131107. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1148%2Frg.324115183\" target=\"_blank\">10.1148\/rg.324115183<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0271-5333\" target=\"_blank\">0271-5333<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=RadioGraphics&rft.atitle=CT+of+the+Hip+Prosthesis%3A+Appearance+of+Components%2C+Fixation%2C+and+Complications&rft.volume=32&rft.issue=4&rft.pages=1089-1107&rft.date=2012&rft_id=info%3Adoi%2F10.1148%2Frg.324115183&rft.issn=0271-5333&rft.aulast=Roth&rft.aufirst=Trenton+D.&rft.au=Maertz%2C+Nathan+A.&rft.au=Parr%2C+J.+Andrew&rft.au=Buckwalter%2C+Kenneth+A.&rft.au=Choplin%2C+Robert+H.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Steffen Breusch, Henrik Malchau (2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.se\/books?id=PQ6NZAeJUXcC&pg=PA337&lpg=PA336\" target=\"_blank\"><i>The Well-Cemented Total Hip Arthroplasty: Theory and Practice<\/i><\/a>. Springer Science & Business Media. p. 336. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-540-24197-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Well-Cemented+Total+Hip+Arthroplasty%3A+Theory+and+Practice&rft.pages=336&rft.pub=Springer+Science+%26+Business+Media&rft.date=2005&rft.isbn=978-3-540-24197-3&rft.au=Steffen+Breusch%2C+Henrik+Malchau&rft_id=https%3A%2F%2Fbooks.google.se%2Fbooks%3Fid%3DPQ6NZAeJUXcC%26pg%3DPA337%26lpg%3DPA336&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Angerame, Marc R.; Fehring, Thomas K.; Masonis, John L.; Mason, J. Bohannon; Odum, Susan M.; Springer, Bryan D. (February 2018). \"Early Failure of Primary Total Hip Arthroplasty: Is Surgical Approach a Risk Factor?\". <i>The Journal of Arthroplasty<\/i>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.arth.2018.01.014\" target=\"_blank\">10.1016\/j.arth.2018.01.014<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Arthroplasty&rft.atitle=Early+Failure+of+Primary+Total+Hip+Arthroplasty%3A+Is+Surgical+Approach+a+Risk+Factor%3F&rft.date=2018-02&rft_id=info%3Adoi%2F10.1016%2Fj.arth.2018.01.014&rft.aulast=Angerame&rft.aufirst=Marc+R.&rft.au=Fehring%2C+Thomas+K.&rft.au=Masonis%2C+John+L.&rft.au=Mason%2C+J.+Bohannon&rft.au=Odum%2C+Susan+M.&rft.au=Springer%2C+Bryan+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Pandit H, Glyn-Jones S, McLardy-Smith P, et al. (July 2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bjj.boneandjoint.org.uk\/cgi\/pmidlookup?view=long&pmid=18591590\" target=\"_blank\">\"Pseudotumours associated with metal-on-metal hip resurfacings\"<\/a>. <i>J Bone Joint Surg Br<\/i>. <b>90<\/b> (7): 847\u201351. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1302%2F0301-620X.90B7.20213\" target=\"_blank\">10.1302\/0301-620X.90B7.20213<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18591590\" target=\"_blank\">18591590<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Br&rft.atitle=Pseudotumours+associated+with+metal-on-metal+hip+resurfacings&rft.volume=90&rft.issue=7&rft.pages=847-51&rft.date=2008-07&rft_id=info%3Adoi%2F10.1302%2F0301-620X.90B7.20213&rft_id=info%3Apmid%2F18591590&rft.aulast=Pandit&rft.aufirst=H&rft.au=Glyn-Jones%2C+S&rft.au=McLardy-Smith%2C+P&rft_id=http%3A%2F%2Fbjj.boneandjoint.org.uk%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D18591590&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Boardman DR, Middleton FR, Kavanagh TG (March 2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/bjj.boneandjoint.org.uk\/cgi\/pmidlookup?view=long&pmid=16498023\" target=\"_blank\">\"A benign psoas mass following metal-on-metal resurfacing of the hip\"<\/a>. <i>J Bone Joint Surg Br<\/i>. <b>88<\/b> (3): 402\u20134. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1302%2F0301-620X.88B3.16748\" target=\"_blank\">10.1302\/0301-620X.88B3.16748<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16498023\" target=\"_blank\">16498023<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Br&rft.atitle=A+benign+psoas+mass+following+metal-on-metal+resurfacing+of+the+hip&rft.volume=88&rft.issue=3&rft.pages=402-4&rft.date=2006-03&rft_id=info%3Adoi%2F10.1302%2F0301-620X.88B3.16748&rft_id=info%3Apmid%2F16498023&rft.aulast=Boardman&rft.aufirst=DR&rft.au=Middleton%2C+FR&rft.au=Kavanagh%2C+TG&rft_id=http%3A%2F%2Fbjj.boneandjoint.org.uk%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D16498023&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><br \/><cite class=\"citation journal\">Korovessis P, Petsinis G, Repanti M, Repantis T (June 2006). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jbjs.org\/article.aspx?volume=88&page=1183\" target=\"_blank\">\"Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up\"<\/a>. <i>J Bone Joint Surg Am<\/i>. <b>88<\/b> (6): 1183\u201391. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.D.02916\" target=\"_blank\">10.2106\/JBJS.D.02916<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16757749\" target=\"_blank\">16757749<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Am&rft.atitle=Metallosis+after+contemporary+metal-on-metal+total+hip+arthroplasty.+Five+to+nine-year+follow-up&rft.volume=88&rft.issue=6&rft.pages=1183-91&rft.date=2006-06&rft_id=info%3Adoi%2F10.2106%2FJBJS.D.02916&rft_id=info%3Apmid%2F16757749&rft.aulast=Korovessis&rft.aufirst=P&rft.au=Petsinis%2C+G&rft.au=Repanti%2C+M&rft.au=Repantis%2C+T&rft_id=http%3A%2F%2Fwww.jbjs.org%2Farticle.aspx%3Fvolume%3D88%26page%3D1183&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Hallab01-38\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Hallab01_38-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Hallab01_38-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hallab N, Merritt K, Jacobs JJ (March 2001). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jbjs.org\/article.aspx?volume=83-A&page=428\" target=\"_blank\">\"Metal sensitivity in patients with orthopaedic implants\"<\/a>. <i>J Bone Joint Surg Am<\/i>. <b>83-A<\/b> (3): 428\u201336. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11263649\" target=\"_blank\">11263649<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Am&rft.atitle=Metal+sensitivity+in+patients+with+orthopaedic+implants&rft.volume=83-A&rft.issue=3&rft.pages=428-36&rft.date=2001-03&rft_id=info%3Apmid%2F11263649&rft.aulast=Hallab&rft.aufirst=N&rft.au=Merritt%2C+K&rft.au=Jacobs%2C+JJ&rft_id=http%3A%2F%2Fwww.jbjs.org%2Farticle.aspx%3Fvolume%3D83-A%26page%3D428&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-39\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-39\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.epi.hss.state.ak.us\/bulletins\/docs\/b2010_14.pdf\" target=\"_blank\">http:\/\/www.epi.hss.state.ak.us\/bulletins\/docs\/b2010_14.pdf<\/a><\/span>\n<\/li>\n<li id=\"cite_note-reuters-20120329-40\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-reuters-20120329_40-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-reuters-20120329_40-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.reuters.com\/article\/2012\/03\/29\/usa-fda-hips-idUSL3E8ET6X820120329\" target=\"_blank\">\"FDA seeks more advice on metal hip implants\"<\/a>. 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Retrieved <span class=\"nowrap\">20 May<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=FDA+seeks+more+advice+on+metal+hip+implants&rft.date=2012-03-29&rft_id=https%3A%2F%2Fwww.reuters.com%2Farticle%2F2012%2F03%2F29%2Fusa-fda-hips-idUSL3E8ET6X820120329&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-41\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-41\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Cot\u00e9, John (July 22, 2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/articles.sfgate.com\/2007-07-22\/news\/17254067_1_hip-replacement-hip-replacement-surgery-blood-clot\" target=\"_blank\">\"Hip replacement is not viewed as high-risk surgery; Death is rare, but underlying medical condition a factor\"<\/a>. <i>San Francisco Chronicle<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=San+Francisco+Chronicle&rft.atitle=Hip+replacement+is+not+viewed+as+high-risk+surgery%3B+Death+is+rare%2C+but+underlying+medical+condition+a+factor&rft.date=2007-07-22&rft.au=Cot%C3%A9%2C+John&rft_id=http%3A%2F%2Farticles.sfgate.com%2F2007-07-22%2Fnews%2F17254067_1_hip-replacement-hip-replacement-surgery-blood-clot&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-42\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-42\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.medscape.com\/viewarticle\/588980\" target=\"_blank\">Medscape Conference Coverage<\/a>, American Academy of Orthopaedic Surgeons (AAOS) 2009 Annual Meeting, AAOS 2009: Certain Factors Increase Risk for Death After Total Hip Arthroplasty, Barbara Boughton, March 3, 2009.<\/span>\n<\/li>\n<li id=\"cite_note-43\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-43\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Mikael, Mark M.; Hanssen, Arlen D.; Sierra, Rafael J. 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title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Int+Orthop&rft.atitle=International+survey+of+primary+and+revision+total+knee+replacement&rft.volume=35&rft.issue=12&rft.pages=1783-9&rft.date=2011&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3224613&rft_id=info%3Apmid%2F21404023&rft_id=info%3Adoi%2F10.1007%2Fs00264-011-1235-5&rft.aulast=Kurtz&rft.aufirst=SM&rft.au=Ong%2C+KL&rft.au=Lau%2C+E&rft.au=Widmer%2C+M&rft.au=Maravic%2C+M&rft.au=G%C3%B3mez-Barrena%2C+E&rft.au=de+Pina+Mde%2C+F&rft.au=Manno%2C+V&rft.au=Torre%2C+M&rft.au=Walter%2C+WL&rft.au=de+Steiger%2C+R&rft.au=Geesink%2C+RG&rft.au=Peltola%2C+M&rft.au=R%C3%B6der%2C+C&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3224613&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-67\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-67\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, Jiranek WA, Berry DJ (2015). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4551172\" target=\"_blank\">\"Prevalence of Total Hip and Knee Replacement in the United States\"<\/a>. <i>J Bone Joint Surg Am<\/i>. <b>97<\/b> (17): 1386\u201397. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.2106%2FJBJS.N.01141\" target=\"_blank\">10.2106\/JBJS.N.01141<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4551172\" target=\"_blank\">4551172<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26333733\" target=\"_blank\">26333733<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J+Bone+Joint+Surg+Am&rft.atitle=Prevalence+of+Total+Hip+and+Knee+Replacement+in+the+United+States&rft.volume=97&rft.issue=17&rft.pages=1386-97&rft.date=2015&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4551172&rft_id=info%3Apmid%2F26333733&rft_id=info%3Adoi%2F10.2106%2FJBJS.N.01141&rft.aulast=Maradit+Kremers&rft.aufirst=H&rft.au=Larson%2C+DR&rft.au=Crowson%2C+CS&rft.au=Kremers%2C+WK&rft.au=Washington%2C+RE&rft.au=Steiner%2C+CA&rft.au=Jiranek%2C+WA&rft.au=Berry%2C+DJ&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4551172&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-68\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-68\" rel=\"external_link\">^<\/a><\/b><\/span> <span 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Blue Cross Blue Shield Association. 21 January 2015. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.bcbs.com\/healthofamerica\/BCBS_BHI_Report-Jan-_21_Final.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 22 October 2015<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">4 October<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=A+study+of+cost+variations+for+knee+and+hip+replacement+surgeries+in+the+U.S.&rft.pub=Blue+Cross+Blue+Shield+Association&rft.date=2015-01-21&rft_id=http%3A%2F%2Fwww.bcbs.com%2Fhealthofamerica%2FBCBS_BHI_Report-Jan-_21_Final.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-69\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-69\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/slideplayer.com\/slide\/1659480\/\" target=\"_blank\">\"History of Artificial Joints - ppt video online download\"<\/a>. <i>slideplayer.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=slideplayer.com&rft.atitle=History+of+Artificial+Joints+-++ppt+video+online+download&rft_id=http%3A%2F%2Fslideplayer.com%2Fslide%2F1659480%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-70\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-70\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brand, RA; Mont, MA; Manring, M (2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3094624\" target=\"_blank\">\"Biographical sketch: Themistocles Gluck (1853\u20131942)\"<\/a>. <i>Clin. 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Res<\/i>. <b>469<\/b> (6): 1525\u20131527. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2Fs11999-011-1836-8\" target=\"_blank\">10.1007\/s11999-011-1836-8<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3094624\" target=\"_blank\">3094624<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21403990\" target=\"_blank\">21403990<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clin.+Orthop.+Relat.+Res.&rft.atitle=Biographical+sketch%3A+Themistocles+Gluck+%281853%E2%80%931942%29&rft.volume=469&rft.issue=6&rft.pages=1525-1527&rft.date=2011&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3094624&rft_id=info%3Apmid%2F21403990&rft_id=info%3Adoi%2F10.1007%2Fs11999-011-1836-8&rft.aulast=Brand&rft.aufirst=RA&rft.au=Mont%2C+MA&rft.au=Manring%2C+M&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3094624&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid16089067-71\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid16089067_71-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gomez PF; Morcuende JA (2005). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1888777\" target=\"_blank\">\"Early attempts at hip arthroplasty\u20141700s to 1950s\"<\/a>. <i>Iowa Orthop J<\/i>. <b>25<\/b>: 25\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1888777\" target=\"_blank\">1888777<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16089067\" target=\"_blank\">16089067<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Iowa+Orthop+J&rft.atitle=Early+attempts+at+hip+arthroplasty%E2%80%941700s+to+1950s&rft.volume=25&rft.pages=25-9&rft.date=2005&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1888777&rft_id=info%3Apmid%2F16089067&rft.au=Gomez+PF&rft.au=Morcuende+JA&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1888777&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-72\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-72\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/orthopedics.about.com\/cs\/jointreplacement1\/p\/austinmoore.htm\" target=\"_blank\">\"What You Need to Know About Joint Replacement Surgery\"<\/a>. <i>about.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=about.com&rft.atitle=What+You+Need+to+Know+About+Joint+Replacement+Surgery&rft_id=http%3A%2F%2Forthopedics.about.com%2Fcs%2Fjointreplacement1%2Fp%2Faustinmoore.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHip+replacement\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20060619082711\/http:\/\/www.edheads.org\/activities\/hip\/\" target=\"_blank\">Edheads Virtual Hip Surgery + Surgery Photos<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/orthoinfo.aaos.org\/fact\/thr_report.cfm?Thread_ID=271&topcategory=Hip\" target=\"_blank\">AAOS Hip Replacement<\/a><\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1332\nCached time: 20181129125012\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 1.024 seconds\nReal time usage: 1.180 seconds\nPreprocessor visited node count: 4852\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 203601\/2097152 bytes\nTemplate argument size: 3090\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 9\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 228472\/5000000 bytes\nNumber of Wikibase entities loaded: 4\/400\nLua time usage: 0.610\/10.000 seconds\nLua memory usage: 9.31 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 988.562 1 -total\n<\/p>\n<pre>63.81% 630.782 1 Template:Reflist\n37.69% 372.617 46 Template:Cite_journal\n11.15% 110.266 13 Template:Cite_web\n 8.60% 85.032 5 Template:Citation_needed\n 7.46% 73.733 5 Template:Fix\n 6.70% 66.232 1 Template:Infobox_medical_intervention\n 6.00% 59.309 1 Template:Infobox\n 5.27% 52.104 1 Template:About\n 4.16% 41.111 6 Template:Convert\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1125423-1!canonical and timestamp 20181129125010 and revision id 870719990\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214702\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.024 seconds\nReal time usage: 0.186 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 174.339 1 - wikipedia:Hip_replacement\n100.00% 174.339 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8200-0!*!*!*!*!*!* and timestamp 20181217214702 and revision id 24346\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Hip_replacement\">https:\/\/www.limswiki.org\/index.php\/Hip_replacement<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","18026209e7901858227ab2cae8f033cf_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2f\/Hip_replacement_Image_3684-PH.jpg\/560px-Hip_replacement_Image_3684-PH.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/da\/Hip_prosthesis_components.jpg\/320px-Hip_prosthesis_components.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0a\/Hip_prosthesis.jpg\/440px-Hip_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/33\/MetalonmetalhipreplaceMark.png\/440px-MetalonmetalhipreplaceMark.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Hip-replacement.jpg\/340px-Hip-replacement.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/92\/Acetabular_inclination_of_hip_prosthesis.jpg\/460px-Acetabular_inclination_of_hip_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/91\/Range_of_acetabular_inclination.png\/460px-Range_of_acetabular_inclination.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/28\/Acetabular_anteversion_of_hip_prosthesis.jpg\/208px-Acetabular_anteversion_of_hip_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/Range_of_acetabular_anteversion.png\/460px-Range_of_acetabular_anteversion.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d7\/Leg_length_discrepancy_after_hip_replacement.jpg\/460px-Leg_length_discrepancy_after_hip_replacement.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Center_of_rotation_of_hip_prosthesis.jpg\/460px-Center_of_rotation_of_hip_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/76\/Dislocated_hip_replacement.jpg\/340px-Dislocated_hip_replacement.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d9\/Hip_prosthesis_liner_creep_and_wear.png\/320px-Hip_prosthesis_liner_creep_and_wear.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b7\/Hip_joint_aseptic_loosening_ar1938-1.png\/340px-Hip_joint_aseptic_loosening_ar1938-1.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/Hip_prosthesis_zones_by_DeLee_and_Charnley_system%2C_and_Gruen_system.jpg\/420px-Hip_prosthesis_zones_by_DeLee_and_Charnley_system%2C_and_Gruen_system.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/4\/47\/Bipolar_hip_prosthesis.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/X-ray_of_hips_with_a_hemiarthroplasty.jpg\/639px-X-ray_of_hips_with_a_hemiarthroplasty.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e0\/Femoral_offset_in_hemiarthroplasty.jpg\/790px-Femoral_offset_in_hemiarthroplasty.jpg"],"18026209e7901858227ab2cae8f033cf_timestamp":1545083222,"fbf0299abb9ffbed2af10e692d621894_type":"article","fbf0299abb9ffbed2af10e692d621894_title":"High-intensity focused ultrasound","fbf0299abb9ffbed2af10e692d621894_url":"https:\/\/www.limswiki.org\/index.php\/High-intensity_focused_ultrasound","fbf0299abb9ffbed2af10e692d621894_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tHigh-intensity focused ultrasound\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article contains content that is written like an advertisement. Please help improve it by removing promotional content and inappropriate external links, and by adding encyclopedic content written from a neutral point of view. (January 2015) (Learn how and when to remove this template message)\nHigh-intensity focused ultrasoundA schematic diagram showing the basic principle of HIFU for treatment of a soft tissue tumour in the liver. The focal region can be placed at depth within a tumour, where a series of adjacent \u2018lesions\u2019 known as a lesion array can be formed as shown.SynonymsMagnetic resonance guided focused ultrasound surgery (MRgFUS), Focused Ultrasound Surgery (FUS)[edit on Wikidata]\nHigh-intensity focused ultrasound (HIFU) is a non-invasive therapeutic technique that uses non-ionizing ultrasonic waves to heat tissue. HIFU can be used to increase the flow of blood or lymph, or to destroy tissue, such as tumors, through a number of mechanisms. The technology can be used to treat a range of disorders and as of 2015 is at various stages of development and commercialization. [1]\nThe technology is similar to ultrasonic imaging, although lower frequencies and continuous, rather than pulsed waves are used to achieve the necessary thermal doses. Acoustic lenses are used to achieve the necessary intensity at the target tissue without damaging the surrounding tissue. An analogy is using a magnifying glass to focus sunlight; only the focal point of the magnifying glass has high intensity. Although lenses have traditionally been used, phased arrays are increasingly common as they allow the focal position to be easily changed. HIFU may be combined with other imaging techniques such as medical ultrasound or MRI to enable guidance of the treatment and monitoring.\n\nContents \n\n1 Medical uses \n\n1.1 Treatments With Approval (FDA or Otherwise) \n\n\n2 Method of use \n\n2.1 Devices and mechanisms \n\n\n3 Mechanism of action \n\n3.1 Theory \n3.2 Focusing \n\n\n4 Image-guidance \n5 History \n6 Approval \n7 References \n8 External links \n\n\nMedical uses \nThis section needs more medical references for verification or relies too heavily on primary sources. Please review the contents of the section and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. (April 2016)\nThere is no clear consensus on the boundaries between HIFU and other forms of therapeutic ultrasound. In academic literature, HIFU usually refers to the high levels of energy required to destroy tissue, although it is also sometimes used to describe lower intensity applications such as occupational therapy and physical therapy.\nEither way, HIFU is used to non-invasively heat tissue deep in the body without making incisions. The main applications are the destruction of tissue, increasing perfusion and physical therapy. The use of ultrasound in the treatment of musculoskeletal conditions however is less common than it was.[2]\n\n Treatments With Approval (FDA or Otherwise) \nEssential tremor, Parkinson's and other neurological disorders\nA focused ultrasound system is approved in Israel, Europe, Korea and Russia to treat essential tremor,[3] neuropathic pain,[4] and Parkinsonian tremor.[5] This approach enables treatment of the brain without incisions and without radiation. In 2016, the US Food and Drug Administration (FDA) approved Insightec\u2019s Exablate Neuro system to treat essential tremor.[6]\nUterine adenomyosis and fibroids\nTreatment for symptomatic uterine fibroids became the first approved application of HIFU by the US Food and Drug Administration (FDA) in October 2004.[7] Studies have shown that HIFU is safe and effective, and that patients have sustained symptomatic relief is sustained for at least two years without the risk of complications involved in surgery or other more invasive approaches.[8] Up to 16-20% of patients will require additional treatment.[9]\nProstate cancer\nHIFU is being studied in men with prostate cancer.[10][11]\nOther cancers\nFurther information: Hyperthermia therapy\nHIFU has been successfully applied in treatment of cancer to destroy solid tumors of the bone, brain, breast, liver,[12] pancreas, rectum, kidney, testes, prostate.[13]\nPalliative care\nHIFU has been found to have palliative effects. CE approval has been given for palliative treatment of bone metastasis.[14] Experimentally, a palliative effect was found in cases of advanced pancreatic cancer.[15]\nHIFU may also be used to produce heating for other purposes than cell destruction. For example, HIFU and other devices may be used to activate temperature-sensitive liposomes filled with cancer drug \"cargo\", to release the drug in high concentrations only at focused tumor sites and when triggered to do so by the hyperthermia device (See Hyperthermia therapy).\n\nCosmetic medicine\nSee also: Non-surgical liposuction\nHIFU devices have been cleared to treat subcutaneous adipose tissue for the purposes of body contouring (known colloquially, and incorrectly since there is no suction involved, as \"non-invasive liposuction\"). These devices are available in the US,[16][17] Canada, the EU, Australia, and certain countries in Asia. HIFU is also cleared, with lower energy levels, for eyebrow lifts.[citation needed ]\n\nOther approved applications\nAn ultrasound-guided device received CE approval for thyroid nodule treatment in 2007, and in 2011 received CE approval for treatment of breast fibroadenoma.[citation needed ]\nAnother device that is guided by optical cameras received CE approval for the treatment of glaucoma in 2011.[18]\n\nMethod of use \nThis section needs more medical references for verification or relies too heavily on primary sources. Please review the contents of the section and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. (April 2016)\nHIFU beams are precisely focused on a small region of diseased tissue to locally deposit high levels of energy. The temperature of tissue at the focus will rise to between 65 and 85 \u00b0C, destroying the diseased tissue by coagulative necrosis. Higher temperatures are usually avoided to prevent boiling of liquids inside the tissue. Each sonication (individual ultrasound energy deposition) treats a precisely defined portion of the targeted tissue. The entire therapeutic target is treated by using multiple sonications to create a volume of treated tissue, according to a protocol developed by the physician. Anesthesia is not required, but sedation is generally recommended.[19]\n\nDevices and mechanisms \nThe focusing effect of the transducer allows high sound pressures to be delivered to a focal point without causing unwanted damage to other tissue. This increase in pressure can cause a number of effects including heating and cavitation.\n\n The transducers differ from ultrasonic imaging probes that lots of people are familiar with. In this picture, two examples of HIFU transducers are shown on the left. They both have acoustic bowl-shaped lenses focus the sound inside the body. For comparison, on the right is an ultrasound imaging probe that might be used for cardiac imaging.\nUltrasound sources may be used to generate regional heating and mechanical changes in biological tissue, e.g. in and cancer treatment.\nFocused ultrasound may be used to generate highly localized heating to treat cysts and tumors (benign or malignant), This is known as Magnetic Resonance guided Focused Ultrasound (MRgFUS) or High Intensity Focused Ultrasound (HIFU). These procedures generally use lower frequencies than medical diagnostic ultrasound (from 0.250 to 2 MHz), but significantly higher energies. HIFU treatment is often guided by MRI.\nFocused ultrasound may be used to break up kidney stones by lithotripsy.\nUltrasound may be used for cataract treatment by phacoemulsification.\nLow-intensity ultrasound has been found to have physiological effects such as ability to stimulate bone-growth, and potential to temporarily disrupt the blood\u2013brain barrier for drug delivery.[20][needs update ]\nIn 2015 the FDA authorized two HIFU devices for the ablation of prostate tissue.[21]\n\nMechanism of action \nAs an acoustic wave propagates through the tissue, part of it is absorbed and converted to heat. With focused beams, a very small region of heating can be achieved deep in tissues (usually on the order of millimeters). Tissue damage occurs as a function of both the temperature to which the tissue is heated and how long the tissue is exposed to this heat level in a metric referred to as \"thermal dose\". By focusing at more than one place or by scanning the focus, a volume can be thermally ablated.[22][23][24]\nThere is some evidence that HIFU can be applied to cancers to disrupt the tumor microenvironment and trigger an immune response, as well as possibly enhance the efficacy of immunotherapy.[25][26] \nAt high enough acoustic intensities, cavitation (microbubbles forming and interacting with the ultrasound field) can occur. Microbubbles produced in the field oscillate and grow (due to factors including rectified diffusion), and can eventually implode (inertial or transient cavitation). During inertial cavitation, very high temperatures occur inside the bubbles, and the collapse is associated with a shock wave and jets that can mechanically damage tissue.[27] Because the onset of cavitation and the resulting tissue damage can be unpredictable, it has generally been avoided in clinical applications thus far. However, researchers have been working on a method of controlling this cavitation, called histotripsy which often involves adding an agent that lowers the temperature at which cavitation occurs.[28][29][30]\n\nTheory \nThere are several ways to focus ultrasound\u2014via a lens (for example, a polystyrene lens), a curved transducer, a phased array, or any combination of the three. This concentrates it into a small focal zone; it is similar in concept to focusing light through a magnifying glass. This can be determined using an exponential model of ultrasound attenuation. The ultrasound intensity profile is bounded by an exponentially decreasing function where the decrease in ultrasound is a function of distance traveled through tissue:\n\n \n \n \n I\n =\n \n I\n \n o\n \n \n \n \n e\n \n \n −\n 2\n α\n \n z\n \n \n \n \n \n {\\displaystyle I=I_{o}{e}^{-2\\alpha \\mathrm {z} }}\n \n\n \n\n<\/p>\n \n \n \n \n I\n \n o\n \n \n \n \n {\\displaystyle I_{o}}\n \n\n is the initial intensity of the beam, \n<\/p>\n \n \n \n α\n \n \n {\\displaystyle \\alpha }\n \n\n is the attenuation coefficient (in units of inverse length), and z is distance traveled through the attenuating medium (e.g. tissue).\n\n<\/p>In this model, \n \n \n \n \n \n \n −\n ∂\n I\n \n \n ∂\n \n z\n \n \n \n \n =\n 2\n α\n I\n =\n Q\n \n \n {\\displaystyle {\\frac {-\\partial I}{\\partial \\mathrm {z} }}=2\\alpha I=Q}\n \n\n [31] is a measure of the power density of the heat absorbed from the ultrasound field. Sometimes, SAR is also used to express the amount of heat absorbed by a specific medium, and is obtained by dividing Q by the tissue density. This demonstrates that tissue heating is proportional to intensity, and that intensity is inversely proportional to the area over which an ultrasound beam is spread\u2014therefore, focusing the beam into a sharp point (i.e. increasing the beam intensity) creates a rapid temperature rise at the focus.[citation needed ]\n\n<\/p>The amount of damage caused in the tissue can be modeled using Cumulative Equivalent Minutes (CEM). Several formulations of the CEM equation have been suggested over the years, but the equation currently in use for most research done in HIFU therapy comes from a 1984 paper by Dewey and Sapareto:[32]\n\n \n \n \n \n \n C\n E\n M\n \n \n =\n \n ∫\n \n \n t\n \n o\n \n \n \n \n \n t\n \n f\n \n \n \n \n \n R\n \n \n T\n \n \n r\n e\n f\n e\n r\n e\n n\n c\n e\n \n \n \n −\n T\n \n \n d\n t\n \n \n {\\displaystyle {\\mathit {CEM}}=\\int _{t_{o}}^{t_{f}}R^{T_{\\mathrm {reference} }-T}dt}\n \n\n \n\n<\/p>with the integral being over the treatment time, R=0.5 for temperatures over 43 \u00b0C and 0.25 for temperatures between 43 \u00b0C and 37 \u00b0C, a reference temperature of 43 \u00b0C, and time in minutes. This formula is an empirical formula derived from experiments performed by Dewey and Sapareto by measuring the survival of cell cultures after exposure to heat.[citation needed ]\n\nFocusing \nThe ultrasound beam can be focused in these ways:\n\nGeometrically, for example with a lens or with a spherically curved transducer.\nElectronically, by adjusting the relative phases of elements in an array of transducers (a \"phased array\"). By dynamically adjusting the electronic signals to the elements of a phased array, the beam can be steered to different locations, and aberrations in the ultrasound beam due to tissue structures can be corrected.[citation needed ]\nImage-guidance \nBecause of the non-invasive nature of HIFU, it is not possible to know where the focal position of the transducer is inside the body. For safe and accurate targeting, HIFU therapy requires monitoring and so is usually performed in conjunction with other imaging techniques.\nX-ray CT is often used prior to transcranial therapy to measure the skull thickness. MRI is often used for localization of target volume, characterization of diffusion, perfusion, flow, and temperature. \nRegular diagnostic ultrasound is of limited use during regular ablation because the acoustic properties of lesioned and unlesioned tissue differ very little. It can be useful if cavitation damage has occurred however as the region will become hyperechoic.[33] A promising new technique is ultrasonic thermography.\n\nHistory \nThis section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2016) (Learn how and when to remove this template message)\nThe first investigations of HIFU for non-invasive ablation were reported by Lynn et al. in the early 1940s. Extensive important early work was performed in the 1950s and 1960s by William Fry and Francis Fry at the University of Illinois and Carl Townsend, Howard White and George Gardner at the Interscience Research Institute of Champaign, Ill., culminating in clinical treatments of neurological disorders. In particular High Intensity ultrasound and ultrasound visualization was accomplished stereotaxically with a Cincinnati precision milling machine to perform accurate ablation of brain tumors. Until recently, clinical trials of HIFU for ablation were few (although significant work in hyperthermia was performed with ultrasonic heating), perhaps due to the complexity of the treatments and the difficulty of targeting the beam noninvasively. With recent advances in medical imaging and ultrasound technology, interest in HIFU ablation of tumors has increased.\nThe first commercial HIFU machine, called the Sonablate 200, was developed by the American company Focus Surgery, Inc. (Milipitas, CA) and launched in Europe in 1994 after receiving CE approval, bringing a first medical validation of the technology for benign prostatic hyperplasia (BPH). Comprehensive studies by practitioners at more than one site using the device demonstrated clinical efficacy for the destruction of prostatic tissue without loss of blood or long term side effects. Later studies on localized prostate cancer by Murat and colleagues at the Edouard Herriot Hospital in Lyon in 2006 showed that after treatment with the Ablatherm (EDAP TMS, Lyon, France), progression-free survival rates are very high for low- and intermediate- risk patients with recurrent prostate cancer (70% and 50% respectively)[34] HIFU treatment of prostate cancer is currently[when? ] an approved therapy in Europe[clarification needed ], Canada, South Korea, Australia, and elsewhere.[citation needed ] As of 2012[update], clinical trials for the Sonablate 500 in the United States are ongoing for prostate cancer patients and those who have experienced radiation failure.[35]\nUse of magnetic resonance-guided focused ultrasound was first cited and patented in 1992.[36][37] The technology was later transferred to InsighTec in Haifa Israel in 1998. The InsighTec ExAblate 2000 was the first MRgFUS system to obtain FDA market approval[7] in the United States.\n\nApproval \nCurrently, there are HIFU systems approved to treat uterine fibroids, pain from bone metastases and the prostate in Asia, Canada, Europe, Israel, Latin America and the United States. There is regulatory approval to treat a range of cancers, including breast, kidney, liver, the pancreas and soft tissue sarcoma in Europe and Asia. There is a brain system approved in Europe, Korea and Russia to treat essential tremor, Parkinsonian tremor and neuropathic pain. Non-image guided HIFU devices may be marketed for cosmetic purposes (typically for body fat reduction) in some jurisdictions.\n\nReferences \n\n\n^ Overview of focused ultrasound \n\n^ Robertson, VJ; Baker, KG (2001). \"A review of therapeutic ultrasound: Effectiveness studies\". Physical Therapy. 81 (7): 1339\u201350. PMID 11444997. \n\n^ Elias, W. 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Chapter 9: The principles of cavitation: Thomson Science, London, Blackie Academic and Professional. pp. 151\u2013182. \n\n^ Maxwell, Adam; Sapozhnikov, Oleg; Bailey, Michael; Crum, Lawrence; Xu, Zhen; Fowlkes, Brian; Cain, Charles; Khokhlova, Vera (2012). \"Disintegration of Tissue Using High Intensity Focused Ultrasound: Two Approaches That Utilize Shock Waves\" (PDF) . Acoustics Today. 8 (4): 24. doi:10.1121\/1.4788649. \n\n^ G., Leighton, T. (1994). The acoustic bubble. London: Academic Press. ISBN 9780124419209. OCLC 30091395. \n\n^ Wrenn, Steven P.; Dicker, Stephen M.; Small, Eleanor F.; Dan, Nily R.; Mleczko, Micha\u0142; Schmitz, Georg; Lewin, Peter A. (2012). \"Bursting Bubbles and Bilayers\". Theranostics. 2 (12): 1140\u201359. doi:10.7150\/thno.4305. PMC 3563150 . PMID 23382772. \n\n^ P Hariharan et al. (2007)[full citation needed ] \n\n^ Sapareto, Stephen A.; Dewey, William C. (1984). \"Thermal dose determination in cancer therapy\". International Journal of Radiation Oncology, Biology, Physics. 10 (6): 787\u2013800. doi:10.1016\/0360-3016(84)90379-1. PMID 6547421. \n\n^ Chan, Arthur H.; Vaezy, Shahram; Crum, Lawrence A. (2003). \"High-intensity Focused Ultrasound\". AccessScience. McGraw-Hill Education. doi:10.1036\/1097-8542.YB031005. \n\n^ Gelet, A; Murat, Fran\u00e7ois-Joseph; Poissonier, L (2007). \"Recurrent Prostate Cancer After Radiotherapy \u2013 Salvage Treatment by High-intensity Focused Ultrasound\". European Oncological Disease. 1 (1): 60\u20132. \n\n^ USHIFU (2012). \"Clinical Information about HIFU in the U.S\". Archived from the original on August 7, 2009. \n\n^ Hynynen, K.; Damianou, C.; Darkazanli, A.; Unger, E.; Levy, M.; Schenck, J. F. (1992). \"On-line MRI monitored noninvasive ultrasound surgery\". Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society: 350\u2013351. doi:10.1109\/IEMBS.1992.5760999. ISBN 978-0-7803-0785-8. \n\n^ US 5247935, \"Magnetic resonance guided focussed ultrasound surgery\", issued March 19, 1992   \n\n\nExternal links \nTherapeutic Ultrasound at Curlie\nDespite Doubts, Cancer Therapy Draws Patients from The New York Times on 18\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/High-intensity_focused_ultrasound\">https:\/\/www.limswiki.org\/index.php\/High-intensity_focused_ultrasound<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 22 February 2016, at 22:54.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,659 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","fbf0299abb9ffbed2af10e692d621894_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-High-intensity_focused_ultrasound skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">High-intensity focused ultrasound<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p><b>High-intensity focused ultrasound<\/b> (<b>HIFU<\/b>) is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Non-invasive_procedure\" title=\"Non-invasive procedure\" rel=\"external_link\" target=\"_blank\">non-invasive<\/a> therapeutic technique that uses non-ionizing ultrasonic waves to heat tissue. HIFU can be used to increase <a href=\"https:\/\/en.wikipedia.org\/wiki\/Perfusion\" title=\"Perfusion\" rel=\"external_link\" target=\"_blank\">the flow of blood or lymph<\/a>, or to destroy tissue, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neoplasm\" title=\"Neoplasm\" rel=\"external_link\" target=\"_blank\">tumors<\/a>, through a number of mechanisms. The technology can be used to treat a range of disorders and as of 2015 is at various stages of development and commercialization. <sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>The technology is similar to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_ultrasound\" title=\"Medical ultrasound\" rel=\"external_link\" target=\"_blank\">ultrasonic imaging<\/a>, although lower frequencies and continuous, rather than pulsed waves are used to achieve the necessary thermal doses. Acoustic lenses are used to achieve the necessary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intensity_(physics)\" title=\"Intensity (physics)\" rel=\"external_link\" target=\"_blank\">intensity<\/a> at the target tissue without damaging the surrounding tissue. An analogy is using a magnifying glass to focus sunlight; only the focal point of the magnifying glass has high intensity. Although lenses have traditionally been used, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phased_array\" title=\"Phased array\" rel=\"external_link\" target=\"_blank\">phased arrays<\/a> are increasingly common as they allow the focal position to be easily changed. HIFU may be combined with other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_imaging\" title=\"Medical imaging\" rel=\"external_link\" target=\"_blank\">imaging techniques<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_ultrasound\" title=\"Medical ultrasound\" rel=\"external_link\" target=\"_blank\">medical ultrasound<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a> to enable guidance of the treatment and monitoring.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n\n<p>There is no clear consensus on the boundaries between HIFU and other forms of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Therapeutic_ultrasound\" title=\"Therapeutic ultrasound\" rel=\"external_link\" target=\"_blank\">therapeutic ultrasound<\/a>. In academic literature, HIFU usually refers to the high levels of energy required to destroy tissue, although it is also sometimes used to describe lower intensity applications such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Occupational_therapy\" title=\"Occupational therapy\" rel=\"external_link\" target=\"_blank\">occupational therapy<\/a> and physical therapy.\n<\/p><p>Either way, HIFU is used to non-invasively heat tissue deep in the body without making incisions. The main applications are the destruction of tissue, increasing perfusion and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_therapy\" title=\"Physical therapy\" rel=\"external_link\" target=\"_blank\">physical therapy<\/a>. The use of ultrasound in the treatment of musculoskeletal conditions however is less common than it was.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Treatments_With_Approval_.28FDA_or_Otherwise.29\"><\/span><span class=\"mw-headline\" id=\"Treatments_With_Approval_(FDA_or_Otherwise)\">Treatments With Approval (FDA or Otherwise)<\/span><\/h3>\n<dl><dt>Essential tremor, Parkinson's and other neurological disorders<\/dt>\n<dd>A focused ultrasound system is approved in Israel, Europe, Korea and Russia to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Essential_tremor\" title=\"Essential tremor\" rel=\"external_link\" target=\"_blank\">essential tremor<\/a>,<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Neuropathic_pain\" title=\"Neuropathic pain\" rel=\"external_link\" target=\"_blank\">neuropathic pain<\/a>,<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Parkinson%27s_disease\" title=\"Parkinson's disease\" rel=\"external_link\" target=\"_blank\">Parkinsonian tremor<\/a>.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> This approach enables treatment of the brain without incisions and without radiation. In 2016, the US Food and Drug Administration (<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">FDA<\/a><\/i>) approved Insightec\u2019s Exablate Neuro system to treat essential tremor.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup><\/dd><\/dl>\n<dl><dt>Uterine adenomyosis and fibroids<\/dt>\n<dd>Treatment for symptomatic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uterine_fibroids\" class=\"mw-redirect\" title=\"Uterine fibroids\" rel=\"external_link\" target=\"_blank\">uterine fibroids<\/a> became the first approved application of HIFU by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration\" title=\"Food and Drug Administration\" rel=\"external_link\" target=\"_blank\">US Food and Drug Administration<\/a> (FDA) in October 2004.<sup id=\"rdp-ebb-cite_ref-FDA_approval_7-0\" class=\"reference\"><a href=\"#cite_note-FDA_approval-7\" rel=\"external_link\">[7]<\/a><\/sup> Studies have shown that HIFU is safe and effective, and that patients have sustained symptomatic relief is sustained for at least two years without the risk of complications involved in surgery or other more invasive approaches.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> Up to 16-20% of patients will require additional treatment.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup><\/dd>\n<dt>Prostate cancer<\/dt>\n<dd>HIFU is being studied in men with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prostate_cancer\" title=\"Prostate cancer\" rel=\"external_link\" target=\"_blank\">prostate cancer<\/a>.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><\/dd><\/dl>\n<dl><dt>Other cancers<\/dt><\/dl>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Further information: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperthermia_therapy\" title=\"Hyperthermia therapy\" rel=\"external_link\" target=\"_blank\">Hyperthermia therapy<\/a><\/div>\n<dl><dd>HIFU has been successfully applied in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oncology\" title=\"Oncology\" rel=\"external_link\" target=\"_blank\">treatment of cancer<\/a> to destroy solid tumors of the bone, brain, breast, liver,<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> pancreas, rectum, kidney, testes, prostate.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><\/dd><\/dl>\n<dl><dt>Palliative care<\/dt><\/dl>\n<p>HIFU has been found to have palliative effects. <a href=\"https:\/\/en.wikipedia.org\/wiki\/CE_marking\" title=\"CE marking\" rel=\"external_link\" target=\"_blank\">CE approval<\/a> has been given for palliative treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_metastasis\" title=\"Bone metastasis\" rel=\"external_link\" target=\"_blank\">bone metastasis<\/a>.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> Experimentally, a palliative effect was found in cases of advanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pancreatic_cancer\" title=\"Pancreatic cancer\" rel=\"external_link\" target=\"_blank\">pancreatic cancer<\/a>.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\n<\/p><p>HIFU may also be used to produce heating for other purposes than cell destruction. For example, HIFU and other devices may be used to activate temperature-sensitive liposomes filled with cancer drug \"cargo\", to release the drug in high concentrations only at focused tumor sites and when triggered to do so by the hyperthermia device (See <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperthermia_therapy\" title=\"Hyperthermia therapy\" rel=\"external_link\" target=\"_blank\">Hyperthermia therapy<\/a>).\n<\/p>\n<dl><dt>Cosmetic medicine<\/dt>\n<dd><div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Non-surgical_liposuction\" class=\"mw-redirect\" title=\"Non-surgical liposuction\" rel=\"external_link\" target=\"_blank\">Non-surgical liposuction<\/a><\/div><\/dd><\/dl>\n<p>HIFU devices have been cleared to treat subcutaneous adipose tissue for the purposes of body contouring (known colloquially, and incorrectly since there is no suction involved, as \"non-invasive liposuction\"). These devices are available in the US,<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup> Canada, the EU, Australia, and certain countries in Asia. HIFU is also cleared, with lower energy levels, for eyebrow lifts.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2015)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<dl><dt>Other approved applications<\/dt>\n<dd>An ultrasound-guided device received CE approval for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thyroid_nodule\" title=\"Thyroid nodule\" rel=\"external_link\" target=\"_blank\">thyroid nodule<\/a> treatment in 2007, and in 2011 received CE approval for treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fibroadenoma\" title=\"Fibroadenoma\" rel=\"external_link\" target=\"_blank\">breast fibroadenoma<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (August 2017)\">citation needed<\/span><\/a><\/i>]<\/sup><\/dd><\/dl>\n<p>Another device that is guided by optical cameras received CE approval for the treatment of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glaucoma\" title=\"Glaucoma\" rel=\"external_link\" target=\"_blank\">glaucoma<\/a> in 2011.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Method_of_use\">Method of use<\/span><\/h2>\n\n<p>HIFU beams are precisely focused on a small region of diseased tissue to locally deposit high levels of energy. The temperature of tissue at the focus will rise to between 65 and 85 \u00b0C, destroying the diseased tissue by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coagulative_necrosis\" title=\"Coagulative necrosis\" rel=\"external_link\" target=\"_blank\">coagulative necrosis<\/a>. Higher temperatures are usually avoided to prevent boiling of liquids inside the tissue. Each <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sonication\" title=\"Sonication\" rel=\"external_link\" target=\"_blank\">sonication<\/a> (individual ultrasound energy deposition) treats a precisely defined portion of the targeted tissue. The entire therapeutic target is treated by using multiple sonications to create a volume of treated tissue, according to a protocol developed by the physician. Anesthesia is not required, but sedation is generally recommended.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Devices_and_mechanisms\">Devices and mechanisms<\/span><\/h3>\n<p>The focusing effect of the transducer allows high sound pressures to be delivered to a focal point without causing unwanted damage to other tissue. This increase in pressure can cause a number of effects including heating and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cavitation\" title=\"Cavitation\" rel=\"external_link\" target=\"_blank\">cavitation<\/a>.\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HIFU_Transducers_Compared_with_Cardiac_Imaging_Probe.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/HIFU_Transducers_Compared_with_Cardiac_Imaging_Probe.jpg\/220px-HIFU_Transducers_Compared_with_Cardiac_Imaging_Probe.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:HIFU_Transducers_Compared_with_Cardiac_Imaging_Probe.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The transducers differ from ultrasonic imaging probes that lots of people are familiar with. In this picture, two examples of HIFU transducers are shown on the left. They both have acoustic bowl-shaped lenses focus the sound inside the body. For comparison, on the right is an ultrasound imaging probe that might be used for cardiac imaging.<\/div><\/div><\/div>\n<ul><li>Ultrasound sources may be used to generate regional heating and mechanical changes in biological tissue, e.g. in and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Experimental_cancer_treatment\" title=\"Experimental cancer treatment\" rel=\"external_link\" target=\"_blank\">cancer treatment<\/a>.<\/li>\n<li>Focused ultrasound may be used to generate highly localized heating to treat cysts and tumors (benign or malignant), This is known as Magnetic Resonance guided Focused Ultrasound (MRgFUS) or High Intensity Focused Ultrasound (HIFU). These procedures generally use lower frequencies than medical diagnostic ultrasound (from 0.250 to 2 MHz), but significantly higher energies. HIFU treatment is often guided by <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a>.<\/li>\n<li>Focused ultrasound may be used to break up <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_stone\" class=\"mw-redirect\" title=\"Kidney stone\" rel=\"external_link\" target=\"_blank\">kidney stones<\/a> by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Extracorporeal_shock_wave_lithotripsy\" class=\"mw-redirect\" title=\"Extracorporeal shock wave lithotripsy\" rel=\"external_link\" target=\"_blank\">lithotripsy<\/a>.<\/li>\n<li>Ultrasound may be used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cataract\" title=\"Cataract\" rel=\"external_link\" target=\"_blank\">cataract<\/a> treatment by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phacoemulsification\" title=\"Phacoemulsification\" rel=\"external_link\" target=\"_blank\">phacoemulsification<\/a>.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Low_intensity_pulsed_ultrasound\" class=\"mw-redirect\" title=\"Low intensity pulsed ultrasound\" rel=\"external_link\" target=\"_blank\">Low-intensity ultrasound<\/a> has been found to have physiological effects such as ability to stimulate bone-growth, and potential to temporarily disrupt the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood%E2%80%93brain_barrier\" title=\"Blood\u2013brain barrier\" rel=\"external_link\" target=\"_blank\">blood\u2013brain barrier<\/a> for drug delivery.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup><sup class=\"noprint Inline-Template\" style=\"margin-left:0.1em; white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Dates_and_numbers#Chronological_items\" title=\"Wikipedia:Manual of Style\/Dates and numbers\" rel=\"external_link\" target=\"_blank\"><span title=\"The text near this tag is dated. (April 2016)\">needs update<\/span><\/a><\/i>]<\/sup><\/li><\/ul>\n<p>In 2015 the FDA authorized two HIFU devices for the ablation of prostate tissue.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Mechanism_of_action\">Mechanism of action<\/span><\/h2>\n<p>As an acoustic wave propagates through the tissue, part of it is absorbed and converted to heat. With focused beams, a very small region of heating can be achieved deep in tissues (usually on the order of millimeters). Tissue damage occurs as a function of both the temperature to which the tissue is heated and how long the tissue is exposed to this heat level in a metric referred to as \"thermal dose\". By focusing at more than one place or by scanning the focus, a volume can be thermally ablated.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup>\n<\/p><p>There is some evidence that HIFU can be applied to cancers to disrupt the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tumor_microenvironment\" title=\"Tumor microenvironment\" rel=\"external_link\" target=\"_blank\">tumor microenvironment<\/a> and trigger an immune response, as well as possibly enhance the efficacy of immunotherapy.<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> \n<\/p><p>At high enough acoustic intensities, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cavitation\" title=\"Cavitation\" rel=\"external_link\" target=\"_blank\">cavitation<\/a> (microbubbles forming and interacting with the ultrasound field) can occur. Microbubbles produced in the field oscillate and grow (due to factors including rectified <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion\" title=\"Diffusion\" rel=\"external_link\" target=\"_blank\">diffusion<\/a>), and can eventually implode (inertial or transient cavitation). During inertial cavitation, very high temperatures occur inside the bubbles, and the collapse is associated with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Shock_wave\" title=\"Shock wave\" rel=\"external_link\" target=\"_blank\">shock wave<\/a> and jets that can mechanically damage tissue.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup> Because the onset of cavitation and the resulting tissue damage can be unpredictable, it has generally been avoided in clinical applications thus far. However, researchers have been working on a method of controlling this cavitation, called histotripsy which often involves adding an agent that lowers the temperature at which cavitation occurs.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Theory\">Theory<\/span><\/h3>\n<p>There are several ways to <a href=\"https:\/\/en.wiktionary.org\/wiki\/focus\" class=\"extiw\" title=\"wikt:focus\" rel=\"external_link\" target=\"_blank\">focus<\/a> ultrasound\u2014via a lens (for example, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polystyrene\" title=\"Polystyrene\" rel=\"external_link\" target=\"_blank\">polystyrene<\/a> lens), a curved <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transducer\" title=\"Transducer\" rel=\"external_link\" target=\"_blank\">transducer<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phased_array\" title=\"Phased array\" rel=\"external_link\" target=\"_blank\">phased array<\/a>, or any combination of the three. This concentrates it into a small focal zone; it is similar in concept to focusing light through a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnifying_glass\" title=\"Magnifying glass\" rel=\"external_link\" target=\"_blank\">magnifying glass<\/a>. This can be determined using an exponential model of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasound_attenuation_spectroscopy\" title=\"Ultrasound attenuation spectroscopy\" rel=\"external_link\" target=\"_blank\">ultrasound attenuation<\/a>. The ultrasound intensity profile is bounded by an exponentially decreasing function where the decrease in ultrasound is a function of distance traveled through tissue:\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/30826c36d2cbdcc18756a1dc7c98d15bdfafc581\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.671ex; width:11.521ex; height:3.009ex;\" alt=\"I=I_{o}{e}^{{-2\\alpha {\\mathrm {z}}}}\"\/><\/span>\n<\/p>\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/6c462307420358828e01df3a8b777bc2fb54f5c0\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.671ex; width:2.053ex; height:2.509ex;\" alt=\"I_o\"\/><\/span> is the initial intensity of the beam, <span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/b79333175c8b3f0840bfb4ec41b8072c83ea88d3\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -0.338ex; width:1.488ex; height:1.676ex;\" alt=\"\\alpha \"\/><\/span> is the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Attenuation_coefficient\" title=\"Attenuation coefficient\" rel=\"external_link\" target=\"_blank\">attenuation coefficient<\/a> (in units of inverse length), and z is distance traveled through the attenuating medium (e.g. tissue).\n<\/p>\n<\/p><p>In this model, <span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/653bc421a42a86e43910263b1c12fbe4b8a71fdf\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -2.005ex; width:16.991ex; height:5.509ex;\" alt=\"{\\frac {-\\partial I}{\\partial {\\mathrm {z}}}}=2\\alpha I=Q\"\/><\/span><sup id=\"rdp-ebb-cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\" rel=\"external_link\">[31]<\/a><\/sup> is a measure of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Power_density\" title=\"Power density\" rel=\"external_link\" target=\"_blank\">power density<\/a> of the heat absorbed from the ultrasound field. Sometimes, SAR is also used to express the amount of heat absorbed by a specific medium, and is obtained by dividing Q by the tissue density. This demonstrates that tissue heating is proportional to intensity, and that intensity is inversely proportional to the area over which an ultrasound beam is spread\u2014therefore, focusing the beam into a sharp point (i.e. increasing the beam intensity) creates a rapid temperature rise at the focus.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2016)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<\/p><p>The amount of damage caused in the tissue can be modeled using Cumulative Equivalent Minutes (CEM). Several formulations of the CEM equation have been suggested over the years, but the equation currently in use for most research done in HIFU therapy comes from a 1984 paper by Dewey and Sapareto:<sup id=\"rdp-ebb-cite_ref-32\" class=\"reference\"><a href=\"#cite_note-32\" rel=\"external_link\">[32]<\/a><\/sup>\n<\/p><p><span class=\"mwe-math-element\"><span class=\"mwe-math-mathml-inline mwe-math-mathml-a11y\" style=\"display: none;\"><\/span><img src=\"https:\/\/wikimedia.org\/api\/rest_v1\/media\/math\/render\/svg\/ca9f450deaf32200408c635153ef2d88e8ec7bff\" class=\"mwe-math-fallback-image-inline\" aria-hidden=\"true\" style=\"vertical-align: -2.671ex; width:25.859ex; height:6.509ex;\" alt=\"{\\mathit {CEM}}=\\int _{{t_{o}}}^{{t_{f}}}R^{{T_{{{\\mathrm {reference}}}}-T}}dt\"\/><\/span>\n<\/p>\n<\/p><p>with the integral being over the treatment time, R=0.5 for temperatures over 43 \u00b0C and 0.25 for temperatures between 43 \u00b0C and 37 \u00b0C, a reference temperature of 43 \u00b0C, and time in minutes. This formula is an empirical formula derived from experiments performed by Dewey and Sapareto by measuring the survival of cell cultures after exposure to heat.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2016)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Focusing\">Focusing<\/span><\/h3>\n<p>The ultrasound beam can be focused in these ways:\n<\/p>\n<ul><li>Geometrically, for example with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lens_(optics)\" title=\"Lens (optics)\" rel=\"external_link\" target=\"_blank\">lens<\/a> or with a spherically curved <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transducer\" title=\"Transducer\" rel=\"external_link\" target=\"_blank\">transducer<\/a>.<\/li>\n<li>Electronically, by adjusting the relative phases of elements in an array of transducers (a \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Phased_array\" title=\"Phased array\" rel=\"external_link\" target=\"_blank\">phased array<\/a>\"). By dynamically adjusting the electronic signals to the elements of a phased array, the beam can be steered to different locations, and aberrations in the ultrasound beam due to tissue structures can be corrected.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2016)\">citation needed<\/span><\/a><\/i>]<\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Image-guidance\">Image-guidance<\/span><\/h2>\n<p>Because of the non-invasive nature of HIFU, it is not possible to know where the focal position of the transducer is inside the body. For safe and accurate targeting, HIFU therapy requires monitoring and so is usually performed in conjunction with other imaging techniques.\n<\/p><p>X-ray <a href=\"https:\/\/en.wikipedia.org\/wiki\/CT_scan\" title=\"CT scan\" rel=\"external_link\" target=\"_blank\">CT<\/a> is often used prior to transcranial therapy to measure the skull thickness. <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a> is often used for localization of target volume, characterization of diffusion, perfusion, flow, and temperature. \n<\/p><p>Regular diagnostic ultrasound is of limited use during regular ablation because the acoustic properties of lesioned and unlesioned tissue differ very little. It can be useful if cavitation damage has occurred however as the region will become hyperechoic.<sup id=\"rdp-ebb-cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\" rel=\"external_link\">[33]<\/a><\/sup> A promising new technique is ultrasonic thermography.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n\n<p>The first investigations of HIFU for non-invasive ablation were reported by Lynn et al. in the early 1940s. Extensive important early work was performed in the 1950s and 1960s by William Fry and Francis Fry at the University of Illinois and Carl Townsend, Howard White and George Gardner at the Interscience Research Institute of Champaign, Ill., culminating in clinical treatments of neurological disorders. In particular High Intensity ultrasound and ultrasound visualization was accomplished stereotaxically with a Cincinnati precision milling machine to perform accurate ablation of brain tumors. Until recently, clinical trials of HIFU for ablation were few (although significant work in hyperthermia was performed with ultrasonic heating), perhaps due to the complexity of the treatments and the difficulty of targeting the beam noninvasively. With recent advances in medical imaging and ultrasound technology, interest in HIFU ablation of tumors has increased.\n<\/p><p>The first commercial HIFU machine, called the Sonablate 200, was developed by the American company Focus Surgery, Inc. (Milipitas, CA) and launched in Europe in 1994 after receiving CE approval, bringing a first medical validation of the technology for benign prostatic hyperplasia (BPH). Comprehensive studies by practitioners at more than one site using the device demonstrated clinical efficacy for the destruction of prostatic tissue without loss of blood or long term side effects. Later studies on localized prostate cancer by Murat and colleagues at the Edouard Herriot Hospital in Lyon in 2006 showed that after treatment with the Ablatherm (EDAP TMS, Lyon, France), progression-free survival rates are very high for low- and intermediate- risk patients with recurrent prostate cancer (70% and 50% respectively)<sup id=\"rdp-ebb-cite_ref-34\" class=\"reference\"><a href=\"#cite_note-34\" rel=\"external_link\">[34]<\/a><\/sup> HIFU treatment of prostate cancer is currently<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Dates_and_numbers#Chronological_items\" title=\"Wikipedia:Manual of Style\/Dates and numbers\" rel=\"external_link\" target=\"_blank\"><span title=\"The time period mentioned near this tag is ambiguous. (December 2016)\">when?<\/span><\/a><\/i>]<\/sup> an approved therapy in Europe<sup class=\"noprint Inline-Template\" style=\"margin-left:0.1em; white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Please_clarify\" title=\"Wikipedia:Please clarify\" rel=\"external_link\" target=\"_blank\"><span title=\"Everywhere in Europe? Including Russia and Turkey? Or just in some countries? Or just the EU? (December 2016)\">clarification needed<\/span><\/a><\/i>]<\/sup>, Canada, South Korea, Australia, and elsewhere.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2016)\">citation needed<\/span><\/a><\/i>]<\/sup> As of 2012<sup class=\"plainlinks noexcerpt noprint asof-tag update\" style=\"display:none;\"><\/sup>, clinical trials for the Sonablate 500 in the United States are ongoing for prostate cancer patients and those who have experienced radiation failure.<sup id=\"rdp-ebb-cite_ref-35\" class=\"reference\"><a href=\"#cite_note-35\" rel=\"external_link\">[35]<\/a><\/sup>\n<\/p><p>Use of magnetic resonance-guided focused ultrasound was first cited and patented in 1992.<sup id=\"rdp-ebb-cite_ref-36\" class=\"reference\"><a href=\"#cite_note-36\" rel=\"external_link\">[36]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-37\" class=\"reference\"><a href=\"#cite_note-37\" rel=\"external_link\">[37]<\/a><\/sup> The technology was later transferred to InsighTec in Haifa Israel in 1998. The InsighTec ExAblate 2000 was the first MRgFUS system to obtain FDA market approval<sup id=\"rdp-ebb-cite_ref-FDA_approval_7-1\" class=\"reference\"><a href=\"#cite_note-FDA_approval-7\" rel=\"external_link\">[7]<\/a><\/sup> in the United States.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Approval\">Approval<\/span><\/h2>\n<p>Currently, there are HIFU systems approved to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uterine_fibroids\" class=\"mw-redirect\" title=\"Uterine fibroids\" rel=\"external_link\" target=\"_blank\">uterine fibroids<\/a>, pain from bone metastases and the prostate in Asia, Canada, Europe, Israel, Latin America and the United States. There is regulatory approval to treat a range of cancers, including breast, kidney, liver, the pancreas and soft tissue sarcoma in Europe and Asia. There is a brain system approved in Europe, Korea and Russia to treat essential tremor, Parkinsonian tremor and neuropathic pain. Non-image guided HIFU devices may be marketed for cosmetic purposes (typically for body fat reduction) in some jurisdictions.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 32em; -webkit-column-width: 32em; column-width: 32em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.fusfoundation.org\/diseases-and-conditions-all\/overview\" target=\"_blank\">Overview of focused ultrasound<\/a><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Robertson, VJ; Baker, KG (2001). \"A review of therapeutic ultrasound: Effectiveness studies\". <i>Physical Therapy<\/i>. <b>81<\/b> (7): 1339\u201350. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11444997\" target=\"_blank\">11444997<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Physical+Therapy&rft.atitle=A+review+of+therapeutic+ultrasound%3A+Effectiveness+studies&rft.volume=81&rft.issue=7&rft.pages=1339-50&rft.date=2001&rft_id=info%3Apmid%2F11444997&rft.aulast=Robertson&rft.aufirst=VJ&rft.au=Baker%2C+KG&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Elias, W. Jeffrey; Huss, Diane; Voss, Tiffini; Loomba, Johanna; Khaled, Mohamad; Zadicario, Eyal; Frysinger, Robert C.; Sperling, Scott A.; Wylie, Scott; Monteith, Stephen J.; Druzgal, Jason; Shah, Binit B.; Harrison, Madaline; Wintermark, Max (2013). \"A Pilot Study of Focused Ultrasound Thalamotomy for Essential Tremor\". <i>New England Journal of Medicine<\/i>. <b>369<\/b> (7): 640\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2FNEJMoa1300962\" target=\"_blank\">10.1056\/NEJMoa1300962<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23944301\" target=\"_blank\">23944301<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=New+England+Journal+of+Medicine&rft.atitle=A+Pilot+Study+of+Focused+Ultrasound+Thalamotomy+for+Essential+Tremor&rft.volume=369&rft.issue=7&rft.pages=640-8&rft.date=2013&rft_id=info%3Adoi%2F10.1056%2FNEJMoa1300962&rft_id=info%3Apmid%2F23944301&rft.aulast=Elias&rft.aufirst=W.+Jeffrey&rft.au=Huss%2C+Diane&rft.au=Voss%2C+Tiffini&rft.au=Loomba%2C+Johanna&rft.au=Khaled%2C+Mohamad&rft.au=Zadicario%2C+Eyal&rft.au=Frysinger%2C+Robert+C.&rft.au=Sperling%2C+Scott+A.&rft.au=Wylie%2C+Scott&rft.au=Monteith%2C+Stephen+J.&rft.au=Druzgal%2C+Jason&rft.au=Shah%2C+Binit+B.&rft.au=Harrison%2C+Madaline&rft.au=Wintermark%2C+Max&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Jeanmonod, Daniel; 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(2007). \"Sustained Relief of Leiomyoma Symptoms by Using Focused Ultrasound Surgery\". <i>Obstetrics & Gynecology<\/i>. <b>110<\/b> (2, Part 1): 279\u201387. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F01.AOG.0000275283.39475.f6\" target=\"_blank\">10.1097\/01.AOG.0000275283.39475.f6<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17666601\" target=\"_blank\">17666601<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Obstetrics+%26+Gynecology&rft.atitle=Sustained+Relief+of+Leiomyoma+Symptoms+by+Using+Focused+Ultrasound+Surgery&rft.volume=110&rft.issue=2%2C+Part+1&rft.pages=279-87&rft.date=2007&rft_id=info%3Adoi%2F10.1097%2F01.AOG.0000275283.39475.f6&rft_id=info%3Apmid%2F17666601&rft.aulast=Stewart&rft.aufirst=Elizabeth+A.&rft.au=Gostout%2C+Bobbie&rft.au=Rabinovici%2C+Jaron&rft.au=Kim%2C+Hyun+S.&rft.au=Regan%2C+Lesley&rft.au=Tempany%2C+Clare+M.+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">J\u00e1come-Pita, F; S\u00e1nchez-Salas, R; Barret, E; Amaruch, N; Gonzalez-Enguita, C; Cathelineau, X (2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4049329\" target=\"_blank\">\"Focal therapy in prostate cancer: the current situation\"<\/a>. <i>Ecancermedicalscience<\/i>. <b>8<\/b>: 435. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3332%2Fecancer.2014.435\" target=\"_blank\">10.3332\/ecancer.2014.435<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4049329\" target=\"_blank\">4049329<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24944577\" target=\"_blank\">24944577<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ecancermedicalscience&rft.atitle=Focal+therapy+in+prostate+cancer%3A+the+current+situation&rft.volume=8&rft.pages=435&rft.date=2014&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4049329&rft_id=info%3Apmid%2F24944577&rft_id=info%3Adoi%2F10.3332%2Fecancer.2014.435&rft.aulast=J%C3%A1come-Pita&rft.aufirst=F&rft.au=S%C3%A1nchez-Salas%2C+R&rft.au=Barret%2C+E&rft.au=Amaruch%2C+N&rft.au=Gonzalez-Enguita%2C+C&rft.au=Cathelineau%2C+X&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4049329&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.medpagetoday.com\/MeetingCoverage\/AUA\/57896\" target=\"_blank\">'Cautious Optimism' for HIFU in Prostate Cancer. 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Philips Healthcare. April 20, 2011. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/new.fusfoundation.org\/Focused-Ultrasound-Technology-News\/philips-sonalleve-receives-ce-mark-for-mr-guided-focused-ultrasound-ablation-of-metastatic-bone-cancer\" target=\"_blank\">the original<\/a> on October 5, 2013<span class=\"reference-accessdate\">. 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Retrieved <span class=\"nowrap\">March 8,<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=510%28k%29+Premarket+Notification+Database&rft.atitle=510%28k%29+Premarket+Notification+-+K112626&rft_id=http%3A%2F%2Fwww.accessdata.fda.gov%2Fscripts%2Fcdrh%2Fcfdocs%2Fcfpmn%2Fpmn.cfm%3FID%3DK112626&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/> Premarket notification, device in classification \"focused ultrasound for tissue heat or mechanical cellular disruption\", classification description \"Focused ultrasound stimulator system for aesthetic use\"<\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/digital.eyeworld.org\/i\/325050-jun-2014\/57\" target=\"_blank\">http:\/\/digital.eyeworld.org\/i\/325050-jun-2014\/57<\/a><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.springer.com\/us\/book\/9783319225357\" target=\"_blank\"><i>Therapeutic Ultrasound<\/i><\/a>. New York: Springer. 2016. pp. 3\u201320. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-319-22536-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Therapeutic+Ultrasound&rft.place=New+York&rft.pages=3-20&rft.pub=Springer&rft.date=2016&rft.isbn=978-3-319-22536-4&rft_id=https%3A%2F%2Fwww.springer.com%2Fus%2Fbook%2F9783319225357&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hynynen, Kullervo; McDannold, Nathan; Sheikov, Nickolai A.; Jolesz, Ferenc A.; Vykhodtseva, Natalia (2005). \"Local and reversible blood\u2013brain barrier disruption by noninvasive focused ultrasound at frequencies suitable for trans-skull sonications\". <i>NeuroImage<\/i>. <b>24<\/b> (1): 12\u201320. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.neuroimage.2004.06.046\" target=\"_blank\">10.1016\/j.neuroimage.2004.06.046<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15588592\" target=\"_blank\">15588592<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=NeuroImage&rft.atitle=Local+and+reversible+blood%E2%80%93brain+barrier+disruption+by+noninvasive+focused+ultrasound+at+frequencies+suitable+for+trans-skull+sonications&rft.volume=24&rft.issue=1&rft.pages=12-20&rft.date=2005&rft_id=info%3Adoi%2F10.1016%2Fj.neuroimage.2004.06.046&rft_id=info%3Apmid%2F15588592&rft.aulast=Hynynen&rft.aufirst=Kullervo&rft.au=McDannold%2C+Nathan&rft.au=Sheikov%2C+Nickolai+A.&rft.au=Jolesz%2C+Ferenc+A.&rft.au=Vykhodtseva%2C+Natalia&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.accessdata.fda.gov\/cdrh_docs\/pdf15\/DEN150011.pdf\" target=\"_blank\">http:\/\/www.accessdata.fda.gov\/cdrh_docs\/pdf15\/DEN150011.pdf<\/a><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"#What_information_to_include\" title=\"Wikipedia:Citing sources\" rel=\"external_link\"><span title=\"A complete citation is needed (April 2016)\">full citation needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-22\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Huisman, Merel; Lam, Mie K; Bartels, Lambertus W; Nijenhuis, Robbert J; Moonen, Chrit T; Knuttel, Floor M; Verkooijen, Helena M; van Vulpen, Marco; van den Bosch, Maurice A (2014). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4193684\" target=\"_blank\">\"Feasibility of volumetric MRI-guided high intensity focused ultrasound (MR-HIFU) for painful bone metastases\"<\/a>. <i>Journal of Therapeutic Ultrasound<\/i>. <b>2<\/b>: 16. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1186%2F2050-5736-2-16\" target=\"_blank\">10.1186\/2050-5736-2-16<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4193684\" target=\"_blank\">4193684<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25309743\" target=\"_blank\">25309743<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Therapeutic+Ultrasound&rft.atitle=Feasibility+of+volumetric+MRI-guided+high+intensity+focused+ultrasound+%28MR-HIFU%29+for+painful+bone+metastases&rft.volume=2&rft.pages=16&rft.date=2014&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4193684&rft_id=info%3Apmid%2F25309743&rft_id=info%3Adoi%2F10.1186%2F2050-5736-2-16&rft.aulast=Huisman&rft.aufirst=Merel&rft.au=Lam%2C+Mie+K&rft.au=Bartels%2C+Lambertus+W&rft.au=Nijenhuis%2C+Robbert+J&rft.au=Moonen%2C+Chrit+T&rft.au=Knuttel%2C+Floor+M&rft.au=Verkooijen%2C+Helena+M&rft.au=van+Vulpen%2C+Marco&rft.au=van+den+Bosch%2C+Maurice+A&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4193684&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-23\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">K\u00f6hler, Max O.; Mougenot, Charles; Quesson, Bruno; Enholm, Julia; Le Bail, Brigitte; Laurent, Christophe; Moonen, Chrit T. W.; Ehnholm, G\u00f6sta J. (2009). \"Volumetric HIFU ablation under 3D guidance of rapid MRI thermometry\". <i>Medical Physics<\/i>. <b>36<\/b> (8): 3521\u201335. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2009MedPh..36.3521K\" target=\"_blank\">2009MedPh..36.3521K<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1118%2F1.3152112\" target=\"_blank\">10.1118\/1.3152112<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19746786\" target=\"_blank\">19746786<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Medical+Physics&rft.atitle=Volumetric+HIFU+ablation+under+3D+guidance+of+rapid+MRI+thermometry&rft.volume=36&rft.issue=8&rft.pages=3521-35&rft.date=2009&rft_id=info%3Apmid%2F19746786&rft_id=info%3Adoi%2F10.1118%2F1.3152112&rft_id=info%3Abibcode%2F2009MedPh..36.3521K&rft.aulast=K%C3%B6hler&rft.aufirst=Max+O.&rft.au=Mougenot%2C+Charles&rft.au=Quesson%2C+Bruno&rft.au=Enholm%2C+Julia&rft.au=Le+Bail%2C+Brigitte&rft.au=Laurent%2C+Christophe&rft.au=Moonen%2C+Chrit+T.+W.&rft.au=Ehnholm%2C+G%C3%B6sta+J.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-24\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Monteith, Stephen J.; Kassell, Neal F.; Goren, Oded; Harnof, Sagi (2013). \"Transcranial MR-guided focused ultrasound sonothrombolysis in the treatment of intracerebral hemorrhage\". <i>Neurosurgical Focus<\/i>. <b>34<\/b> (5): E14. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3171%2F2013.2.FOCUS1313\" target=\"_blank\">10.3171\/2013.2.FOCUS1313<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23634918\" target=\"_blank\">23634918<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neurosurgical+Focus&rft.atitle=Transcranial+MR-guided+focused+ultrasound+sonothrombolysis+in+the+treatment+of+intracerebral+hemorrhage&rft.volume=34&rft.issue=5&rft.pages=E14&rft.date=2013&rft_id=info%3Adoi%2F10.3171%2F2013.2.FOCUS1313&rft_id=info%3Apmid%2F23634918&rft.aulast=Monteith&rft.aufirst=Stephen+J.&rft.au=Kassell%2C+Neal+F.&rft.au=Goren%2C+Oded&rft.au=Harnof%2C+Sagi&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Haen, Sebastian P.; Pereira, Philippe L.; Salih, Helmut R.; Rammensee, Hans-Georg; Gouttefangeas, C\u00e9cile (2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3254009\" target=\"_blank\">\"More Than Just Tumor Destruction: Immunomodulation by Thermal Ablation of Cancer\"<\/a>. <i>Clinical and Developmental Immunology<\/i>. <b>2011<\/b>: 1\u201319. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1155%2F2011%2F160250\" target=\"_blank\">10.1155\/2011\/160250<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3254009\" target=\"_blank\">3254009<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22242035\" target=\"_blank\">22242035<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+and+Developmental+Immunology&rft.atitle=More+Than+Just+Tumor+Destruction%3A+Immunomodulation+by+Thermal+Ablation+of+Cancer&rft.volume=2011&rft.pages=1-19&rft.date=2011&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3254009&rft_id=info%3Apmid%2F22242035&rft_id=info%3Adoi%2F10.1155%2F2011%2F160250&rft.aulast=Haen&rft.aufirst=Sebastian+P.&rft.au=Pereira%2C+Philippe+L.&rft.au=Salih%2C+Helmut+R.&rft.au=Rammensee%2C+Hans-Georg&rft.au=Gouttefangeas%2C+C%C3%A9cile&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3254009&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-26\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wu, Feng (2013). \"High intensity focused ultrasound ablation and antitumor immune response\". <i>The Journal of the Acoustical Society of America<\/i>. <b>134<\/b> (2): 1695\u2013701. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2013ASAJ..134.1695W\" target=\"_blank\">2013ASAJ..134.1695W<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1121%2F1.4812893\" target=\"_blank\">10.1121\/1.4812893<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23927210\" target=\"_blank\">23927210<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+the+Acoustical+Society+of+America&rft.atitle=High+intensity+focused+ultrasound+ablation+and+antitumor+immune+response&rft.volume=134&rft.issue=2&rft.pages=1695-701&rft.date=2013&rft_id=info%3Apmid%2F23927210&rft_id=info%3Adoi%2F10.1121%2F1.4812893&rft_id=info%3Abibcode%2F2013ASAJ..134.1695W&rft.aulast=Wu&rft.aufirst=Feng&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Leighton, T.G. 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(1994). <i>The acoustic bubble<\/i>. London: Academic Press. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9780124419209. <a href=\"https:\/\/en.wikipedia.org\/wiki\/OCLC\" title=\"OCLC\" rel=\"external_link\" target=\"_blank\">OCLC<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/oclc\/30091395\" target=\"_blank\">30091395<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+acoustic+bubble&rft.place=London&rft.pub=Academic+Press&rft.date=1994&rft_id=info%3Aoclcnum%2F30091395&rft.isbn=9780124419209&rft.aulast=G.&rft.aufirst=Leighton%2C+T.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wrenn, Steven P.; Dicker, Stephen M.; Small, Eleanor F.; Dan, Nily R.; Mleczko, Micha\u0142; Schmitz, Georg; Lewin, Peter A. (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3563150\" target=\"_blank\">\"Bursting Bubbles and Bilayers\"<\/a>. <i>Theranostics<\/i>. <b>2<\/b> (12): 1140\u201359. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.7150%2Fthno.4305\" target=\"_blank\">10.7150\/thno.4305<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3563150\" target=\"_blank\">3563150<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23382772\" target=\"_blank\">23382772<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Theranostics&rft.atitle=Bursting+Bubbles+and+Bilayers&rft.volume=2&rft.issue=12&rft.pages=1140-59&rft.date=2012&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3563150&rft_id=info%3Apmid%2F23382772&rft_id=info%3Adoi%2F10.7150%2Fthno.4305&rft.aulast=Wrenn&rft.aufirst=Steven+P.&rft.au=Dicker%2C+Stephen+M.&rft.au=Small%2C+Eleanor+F.&rft.au=Dan%2C+Nily+R.&rft.au=Mleczko%2C+Micha%C5%82&rft.au=Schmitz%2C+Georg&rft.au=Lewin%2C+Peter+A.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3563150&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-31\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">P Hariharan et al. (2007)<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"#What_information_to_include\" title=\"Wikipedia:Citing sources\" rel=\"external_link\"><span title=\"A complete citation is needed (April 2016)\">full citation needed<\/span><\/a><\/i>]<\/sup><\/span>\n<\/li>\n<li id=\"cite_note-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-32\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sapareto, Stephen A.; Dewey, William C. (1984). \"Thermal dose determination in cancer therapy\". <i>International Journal of Radiation Oncology, Biology, Physics<\/i>. <b>10<\/b> (6): 787\u2013800. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2F0360-3016%2884%2990379-1\" target=\"_blank\">10.1016\/0360-3016(84)90379-1<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6547421\" target=\"_blank\">6547421<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Radiation+Oncology%2C+Biology%2C+Physics&rft.atitle=Thermal+dose+determination+in+cancer+therapy&rft.volume=10&rft.issue=6&rft.pages=787-800&rft.date=1984&rft_id=info%3Adoi%2F10.1016%2F0360-3016%2884%2990379-1&rft_id=info%3Apmid%2F6547421&rft.aulast=Sapareto&rft.aufirst=Stephen+A.&rft.au=Dewey%2C+William+C.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-33\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chan, Arthur H.; Vaezy, Shahram; Crum, Lawrence A. (2003). \"High-intensity Focused Ultrasound\". <i>AccessScience<\/i>. McGraw-Hill Education. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1036%2F1097-8542.YB031005\" target=\"_blank\">10.1036\/1097-8542.YB031005<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=AccessScience&rft.atitle=High-intensity+Focused+Ultrasound&rft.date=2003&rft_id=info%3Adoi%2F10.1036%2F1097-8542.YB031005&rft.aulast=Chan&rft.aufirst=Arthur+H.&rft.au=Vaezy%2C+Shahram&rft.au=Crum%2C+Lawrence+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-34\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-34\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gelet, A; Murat, Fran\u00e7ois-Joseph; Poissonier, L (2007). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.touchoncology.com\/articles\/recurrent-prostate-cancer-after-radiotherapy-salvage-treatment-high-intensity-focused-ultra\" target=\"_blank\">\"Recurrent Prostate Cancer After Radiotherapy \u2013 Salvage Treatment by High-intensity Focused Ultrasound\"<\/a>. <i>European Oncological Disease<\/i>. <b>1<\/b> (1): 60\u20132.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Oncological+Disease&rft.atitle=Recurrent+Prostate+Cancer+After+Radiotherapy+%E2%80%93+Salvage+Treatment+by+High-intensity+Focused+Ultrasound&rft.volume=1&rft.issue=1&rft.pages=60-2&rft.date=2007&rft.aulast=Gelet&rft.aufirst=A&rft.au=Murat%2C+Fran%C3%A7ois-Joseph&rft.au=Poissonier%2C+L&rft_id=http%3A%2F%2Fwww.touchoncology.com%2Farticles%2Frecurrent-prostate-cancer-after-radiotherapy-salvage-treatment-high-intensity-focused-ultra&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-35\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-35\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">USHIFU (2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20090807071512\/http:\/\/www.ushifu.com\/index.php?option=com_content&view=article&id=3&Itemid=3\" target=\"_blank\">\"Clinical Information about HIFU in the U.S\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ushifu.com\/index.php?option=com_content&view=article&id=3&Itemid=3\" target=\"_blank\">the original<\/a> on August 7, 2009.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Clinical+Information+about+HIFU+in+the+U.S&rft.date=2012&rft.au=USHIFU&rft_id=http%3A%2F%2Fwww.ushifu.com%2Findex.php%3Foption%3Dcom_content%26view%3Darticle%26id%3D3%26Itemid%3D3&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-36\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-36\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hynynen, K.; Damianou, C.; Darkazanli, A.; Unger, E.; Levy, M.; Schenck, J. F. (1992). \"On-line MRI monitored noninvasive ultrasound surgery\". <i>Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society<\/i>: 350\u2013351. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1109%2FIEMBS.1992.5760999\" target=\"_blank\">10.1109\/IEMBS.1992.5760999<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-7803-0785-8.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Proceedings+of+the+Annual+International+Conference+of+the+IEEE+Engineering+in+Medicine+and+Biology+Society&rft.atitle=On-line+MRI+monitored+noninvasive+ultrasound+surgery&rft.pages=350-351&rft.date=1992&rft_id=info%3Adoi%2F10.1109%2FIEMBS.1992.5760999&rft.isbn=978-0-7803-0785-8&rft.aulast=Hynynen&rft.aufirst=K.&rft.au=Damianou%2C+C.&rft.au=Darkazanli%2C+A.&rft.au=Unger%2C+E.&rft.au=Levy%2C+M.&rft.au=Schenck%2C+J.+F.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHigh-intensity+focused+ultrasound\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-37\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-37\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><span class=\"citation patent\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/worldwide.espacenet.com\/textdoc?DB=EPODOC&IDX=US5247935\" target=\"_blank\">US 5247935<\/a>, \"Magnetic resonance guided focussed ultrasound surgery\", issued March 19, 1992<\/span><span class=\"Z3988\" title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Apatent&rft.number=5247935&rft.cc=US&rft.title=Magnetic+resonance+guided+focussed+ultrasound+surgery&rft.date=March 19, 1992&rft.appldate=March 19, 1992\"><span style=\"display: none;\"> <\/span><\/span><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/curlie.org\/Science\/Technology\/Acoustics,_Ultrasound_and_Vibration\/Ultrasound\/Therapeutic_Ultrasound\" target=\"_blank\">Therapeutic Ultrasound<\/a> at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Curlie\" title=\"Curlie\" rel=\"external_link\" target=\"_blank\">Curlie<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2008\/01\/18\/health\/18prostate.html?_r=1&fta=y\" target=\"_blank\">Despite Doubts, Cancer Therapy Draws Patients<\/a> from <i>The New York Times<\/i> on 18<\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1255\nCached time: 20181217214702\nCache expiry: 3600\nDynamic content: true\nCPU time usage: 0.796 seconds\nReal time usage: 0.980 seconds\nPreprocessor visited node count: 4270\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 114671\/2097152 bytes\nTemplate argument size: 7355\/2097152 bytes\nHighest expansion depth: 21\/40\nExpensive parser function count: 16\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 91613\/5000000 bytes\nNumber of Wikibase entities loaded: 5\/400\nLua time usage: 0.474\/10.000 seconds\nLua memory usage: 5.9 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 846.896 1 -total\n<\/p>\n<pre>52.32% 443.094 1 Template:Reflist\n32.79% 277.719 21 Template:Cite_journal\n12.88% 109.109 9 Template:Fix\n 9.44% 79.925 5 Template:Citation_needed\n 8.97% 75.984 10 Template:Delink\n 8.76% 74.164 1 Template:Infobox_medical_intervention\n 8.25% 69.907 1 Template:Infobox\n 7.98% 67.585 1 Template:Advert\n 6.51% 55.110 4 Template:Ambox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:3606007-1!canonical!math=5 and timestamp 20181217214701 and revision id 864025477\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/High-intensity_focused_ultrasound\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214702\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.021 seconds\nReal time usage: 1.169 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 1158.558 1 - wikipedia:High-intensity_focused_ultrasound\n100.00% 1158.558 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8020-0!*!*!*!*!*!* and timestamp 20181217214700 and revision id 24131\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/High-intensity_focused_ultrasound\">https:\/\/www.limswiki.org\/index.php\/High-intensity_focused_ultrasound<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","fbf0299abb9ffbed2af10e692d621894_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/78\/Diagram_showing_liver_lesioning_using_a_HIFU_transducer.png\/560px-Diagram_showing_liver_lesioning_using_a_HIFU_transducer.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e3\/Rod_of_Asclepius2.svg\/25px-Rod_of_Asclepius2.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/HIFU_Transducers_Compared_with_Cardiac_Imaging_Probe.jpg\/440px-HIFU_Transducers_Compared_with_Cardiac_Imaging_Probe.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png"],"fbf0299abb9ffbed2af10e692d621894_timestamp":1545083220,"e1d34a169eacda7dd24e34bd666ecd73_type":"article","e1d34a169eacda7dd24e34bd666ecd73_title":"Harding test","e1d34a169eacda7dd24e34bd666ecd73_url":"https:\/\/www.limswiki.org\/index.php\/Harding_test","e1d34a169eacda7dd24e34bd666ecd73_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tHarding test\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThe term Harding test is generically understood to mean an automatic test for photosensitive epilepsy (PSE) provocative image sequences in television content. This is properly known as a PSE test since the publication of the Digital Production Partnership (DPP) technical requirements[1] and the DPP PSE Devices[2] document (in the UK) updated in November 2018.\nThe Harding FPA (flash and pattern analyser) is proprietary software that is used to analyse video content for flashing and stationary patterns which may cause harm to those who suffer from photosensitive epilepsy. It is an implementation of the guidelines set by the regulator Ofcom in the UK. It is available in both tape-based and file-based versions, allowing video streams from SDI, composite, component, HDMI, and files to all be analysed, in resolutions up to 8k. Versions for both Microsoft Windows and Apple Mac OS X are available. There are other manufacturers of similar and different solutions now available which are also approved on the DPP Devices list.[3]\n\nPhotosensitive epilepsy \nPhotosensitive epilepsy affects approximately one in 4,000 people and is a form of epilepsy in which seizures are triggered by visual stimuli that form patterns in time or space, such as flashing lights, bold regular patterns, or regular moving patterns. In 1993, an advert for Pot Noodles induced seizures in three people in the United Kingdom, leading to the then regulator the ITC introducing these guidelines. \nThe Broadcast Code of Advertising Practice requires that TV ads are tested and pass the 'flash test'. Clearcast, the company responsible for clearing ads for UK commercial broadcasters, is flash testing all ads before clearance.\n\nTesting procedures \nThe algorithms behind PSE testing look at video frames from second to second and analyse for potentially provocative image sequences. Luminance flashes, Red flashes and spatial patterns over prescribed amplitude and frequency limits are then logged. Any such over limit violations give rise to the media being failed. Otherwise the media is passed fit for broadcast and a pass certificate can be automatically generated.\nThe first PSE test was developed by Cambridge Research Systems Ltd. and are based on research by Professor Graham Harding.[4] All Harding FPA products implement the same guidelines. There are also other approved manufacturers' products which either use the same algorithm in different packages or have independently developed software and algorithms that broadly provide PSE checks to the same specifications.\nThe PSE testing is currently used by all television stations in the UK to check for compliance with the guidelines. If a programme fails, it usually means re-editing the offending scenes. Normally the problem can be rectified by reducing the number of flashes in the scene and\/or reducing the intensity of colours (most notably saturated red).[5] After re-editing the problem areas, the entire programme has to be re-tested in order to obtain a PSE test certificate.\nIn 2010, HardingTest.com was launched to provide users with a way of testing video remotely, without the need to have an in-house Harding FPA machine. This provided a much-needed service for freelance editors and smaller production companies who previously had to export their movie to video tape to send to a larger post-production facility for testing, all of which increased time and expense. This service means users can upload a digital video file and have it tested and results returned within minutes rather than hours.\n\nReferences \n\n\n^ \"Technical Standards\". DPP. Archived from the original on 2014-10-21. \n\n^ \"PSE Devices\". DPP. Retrieved 2018-11-28 . \n\n^ \"How To Interpret HardingFPA Results\". Cambridge Research Systems Ltd. 2011. Retrieved 23 February 2016 . \n\n^ \"Epilepsy fears over 2012 footage\". BBC News. London. 2007-06-05. Retrieved 2008-04-09 . \n\n^ Harding, G.F.; Harding, P.F. (2010). \"Photosensitive epilepsy and image safety\". Applied Ergonomics. 41 (4): 504\u2013508. doi:10.1016\/j.apergo.2008.08.005. PMID 18930180. \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Harding_test\">https:\/\/www.limswiki.org\/index.php\/Harding_test<\/a>\n\t\t\t\t\tCategories: Medical and surgical techniquesMedical softwareHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 23 February 2016, at 21:40.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 416 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","e1d34a169eacda7dd24e34bd666ecd73_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Harding_test skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Harding test<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p>The term <b>Harding test<\/b> is generically understood to mean an automatic test for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photosensitive_epilepsy\" title=\"Photosensitive epilepsy\" rel=\"external_link\" target=\"_blank\">photosensitive epilepsy<\/a> (PSE) provocative image sequences in television content. This is properly known as a PSE test since the publication of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_Production_Partnership_(DPP)\" class=\"mw-redirect\" title=\"Digital Production Partnership (DPP)\" rel=\"external_link\" target=\"_blank\">Digital Production Partnership (DPP)<\/a> technical requirements<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> and the DPP PSE Devices<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> document (in the UK) updated in November 2018.\n<\/p><p>The Harding FPA (flash and pattern analyser) is proprietary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Software\" title=\"Software\" rel=\"external_link\" target=\"_blank\">software<\/a> that is used to analyse video content for flashing and stationary patterns which may cause harm to those who suffer from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Photosensitive_epilepsy\" title=\"Photosensitive epilepsy\" rel=\"external_link\" target=\"_blank\">photosensitive epilepsy<\/a>. It is an implementation of the guidelines set by the regulator <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ofcom\" title=\"Ofcom\" rel=\"external_link\" target=\"_blank\">Ofcom<\/a> in the UK. It is available in both tape-based and file-based versions, allowing video streams from SDI, composite, component, HDMI, and files to all be analysed, in resolutions up to 8k. Versions for both Microsoft Windows and Apple Mac OS X are available. There are other manufacturers of similar and different solutions now available which are also approved on the DPP Devices list.<sup id=\"rdp-ebb-cite_ref-HardingProds_3-0\" class=\"reference\"><a href=\"#cite_note-HardingProds-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Photosensitive_epilepsy\">Photosensitive epilepsy<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Photosensitive_epilepsy\" title=\"Photosensitive epilepsy\" rel=\"external_link\" target=\"_blank\">Photosensitive epilepsy<\/a> affects approximately one in 4,000 people and is a form of epilepsy in which seizures are triggered by visual stimuli that form patterns in time or space, such as flashing lights, bold regular patterns, or regular moving patterns. In 1993, an advert for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pot_Noodles\" class=\"mw-redirect\" title=\"Pot Noodles\" rel=\"external_link\" target=\"_blank\">Pot Noodles<\/a> induced seizures in three people in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_Kingdom\" title=\"United Kingdom\" rel=\"external_link\" target=\"_blank\">United Kingdom<\/a>, leading to the then regulator the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Independent_Television_Commission\" title=\"Independent Television Commission\" rel=\"external_link\" target=\"_blank\">ITC<\/a> introducing these guidelines. \n<\/p><p>The Broadcast Code of Advertising Practice requires that TV ads are tested and pass the 'flash test'. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clearcast\" title=\"Clearcast\" rel=\"external_link\" target=\"_blank\">Clearcast<\/a>, the company responsible for clearing ads for UK commercial broadcasters, is flash testing all ads before clearance.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Testing_procedures\">Testing procedures<\/span><\/h2>\n<p>The algorithms behind PSE testing look at video frames from second to second and analyse for potentially provocative image sequences. Luminance flashes, Red flashes and spatial patterns over prescribed amplitude and frequency limits are then logged. Any such over limit violations give rise to the media being failed. Otherwise the media is passed fit for broadcast and a pass certificate can be automatically generated.\n<\/p><p>The first PSE test was developed by Cambridge Research Systems Ltd. and are based on research by Professor Graham Harding.<sup id=\"rdp-ebb-cite_ref-titleBBC_NEWS_|_England_|_London_|_Epilepsy_fears_over_2012_footage_4-0\" class=\"reference\"><a href=\"#cite_note-titleBBC_NEWS_|_England_|_London_|_Epilepsy_fears_over_2012_footage-4\" rel=\"external_link\">[4]<\/a><\/sup> All Harding FPA products implement the same guidelines. There are also other approved manufacturers' products which either use the same algorithm in different packages or have independently developed software and algorithms that broadly provide PSE checks to the same specifications.\n<\/p><p>The PSE testing is currently used by all <a href=\"https:\/\/en.wikipedia.org\/wiki\/Television\" title=\"Television\" rel=\"external_link\" target=\"_blank\">television<\/a> stations in the UK to check for compliance with the guidelines. If a programme fails, it usually means re-editing the offending scenes. Normally the problem can be rectified by reducing the number of flashes in the scene and\/or reducing the intensity of colours (most notably saturated red).<sup id=\"rdp-ebb-cite_ref-HardingPhoto10_5-0\" class=\"reference\"><a href=\"#cite_note-HardingPhoto10-5\" rel=\"external_link\">[5]<\/a><\/sup> After re-editing the problem areas, the entire programme has to be re-tested in order to obtain a PSE test certificate.\n<\/p><p>In 2010, <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/HardingTest.com\" target=\"_blank\">HardingTest.com<\/a> was launched to provide users with a way of testing video remotely, without the need to have an in-house Harding FPA machine. This provided a much-needed service for freelance editors and smaller production companies who previously had to export their movie to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Video_tape\" class=\"mw-redirect\" title=\"Video tape\" rel=\"external_link\" target=\"_blank\">video tape<\/a> to send to a larger <a href=\"https:\/\/en.wikipedia.org\/wiki\/Post-production\" title=\"Post-production\" rel=\"external_link\" target=\"_blank\">post-production<\/a> facility for testing, all of which increased time and expense. This service means users can upload a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_video\" title=\"Digital video\" rel=\"external_link\" target=\"_blank\">digital video<\/a> file and have it tested and results returned within minutes rather than hours.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20141021053640\/http:\/\/www.digitalproductionpartnership.co.uk\/downloads\/standards\/\" target=\"_blank\">\"Technical Standards\"<\/a>. DPP. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.digitalproductionpartnership.co.uk\/downloads\/standards\/\" target=\"_blank\">the original<\/a> on 2014-10-21.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Technical+Standards&rft.pub=DPP&rft_id=http%3A%2F%2Fwww.digitalproductionpartnership.co.uk%2Fdownloads%2Fstandards%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHarding+test\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"#publication-6902\">\"PSE Devices\"<\/a>. DPP<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-11-28<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=PSE+Devices&rft.pub=DPP&rft_id=https%3A%2F%2Fwww.digitalproductionpartnership.co.uk%2Fpublications%2Ftype%2Ftechnical-guides%2F%23publication-6902&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHarding+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-HardingProds-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-HardingProds_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hardingfpa.com\/technical-support\/how-to-interpret-hardingfpa-results\/\" target=\"_blank\">\"How To Interpret HardingFPA Results\"<\/a>. Cambridge Research Systems Ltd. 2011<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">23 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=How+To+Interpret+HardingFPA+Results&rft.pub=Cambridge+Research+Systems+Ltd&rft.date=2011&rft_id=http%3A%2F%2Fwww.hardingfpa.com%2Ftechnical-support%2Fhow-to-interpret-hardingfpa-results%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHarding+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-titleBBC_NEWS_|_England_|_London_|_Epilepsy_fears_over_2012_footage-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-titleBBC_NEWS_|_England_|_London_|_Epilepsy_fears_over_2012_footage_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/news.bbc.co.uk\/1\/hi\/england\/london\/6724245.stm\" target=\"_blank\">\"Epilepsy fears over 2012 footage\"<\/a>. <i>BBC News<\/i>. London. 2007-06-05<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2008-04-09<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BBC+News&rft.atitle=Epilepsy+fears+over+2012+footage&rft.date=2007-06-05&rft_id=http%3A%2F%2Fnews.bbc.co.uk%2F1%2Fhi%2Fengland%2Flondon%2F6724245.stm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHarding+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-HardingPhoto10-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-HardingPhoto10_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Harding, G.F.; Harding, P.F. (2010). \"Photosensitive epilepsy and image safety\". <i>Applied Ergonomics<\/i>. <b>41<\/b> (4): 504\u2013508. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.apergo.2008.08.005\" target=\"_blank\">10.1016\/j.apergo.2008.08.005<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18930180\" target=\"_blank\">18930180<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Applied+Ergonomics&rft.atitle=Photosensitive+epilepsy+and+image+safety&rft.volume=41&rft.issue=4&rft.pages=504-508&rft.date=2010&rft_id=info%3Adoi%2F10.1016%2Fj.apergo.2008.08.005&rft_id=info%3Apmid%2F18930180&rft.au=Harding%2C+G.F.&rft.au=Harding%2C+P.F.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHarding+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1326\nCached time: 20181130065951\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.124 seconds\nReal time usage: 0.156 seconds\nPreprocessor visited node count: 280\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 7184\/2097152 bytes\nTemplate argument size: 76\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 13246\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.080\/10.000 seconds\nLua memory usage: 2.38 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 138.761 1 Template:Reflist\n100.00% 138.761 1 -total\n<\/p>\n<pre>56.54% 78.450 3 Template:Cite_web\n25.54% 35.442 1 Template:Cite_journal\n 5.45% 7.566 1 Template:Cite_news\n 1.90% 2.631 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:16153400-1!canonical and timestamp 20181130065951 and revision id 871272375\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Harding_test\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214700\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.143 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 137.435 1 - wikipedia:Harding_test\n100.00% 137.435 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8104-0!*!*!*!*!*!* and timestamp 20181217214700 and revision id 24223\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Harding_test\">https:\/\/www.limswiki.org\/index.php\/Harding_test<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","e1d34a169eacda7dd24e34bd666ecd73_images":[],"e1d34a169eacda7dd24e34bd666ecd73_timestamp":1545083220,"5ff6b49fb2382d04d168fa8c319633ae_type":"article","5ff6b49fb2382d04d168fa8c319633ae_title":"Glucose test","5ff6b49fb2382d04d168fa8c319633ae_url":"https:\/\/www.limswiki.org\/index.php\/Glucose_test","5ff6b49fb2382d04d168fa8c319633ae_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tGlucose test\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tGlucose testMedical diagnosticsPurposeestimate blood sugar levels\nMany types of glucose tests exist and they can be used to estimate blood sugar levels at a given time or, over a longer period of time, to obtain average levels or to see how fast body is able to normalize changed glucose levels. Eating food for example leads to elevated blood sugar levels. In healthy people these levels quickly return to normal via increased cellular glucose uptake which is primarily mediated by increase in blood insulin levels.\nGlucose tests can reveal temporary\/long-term hyperglycemia or hypoglycemia. These conditions may not have obvious symptoms and can damage organs in the long-term. Abnormally high\/low levels, slow return to normal levels from either of these conditions and\/or inability to normalize blood sugar levels means that the person being tested probably has some kind of medical condition like type 2 diabetes which is caused by cellular insensitivity to insulin. Glucose tests are thus often used to diagnose such conditions.\n\nContents \n\n1 Testing methods \n2 Use in medical diagnosis \n3 Preparing for testing \n4 Reference ranges \n\n4.1 Fasting blood sugar \n4.2 Glucose tolerance test \n4.3 Postprandial glucose test \n4.4 Random glucose test \n\n\n5 See also \n6 References \n\n\nTesting methods \nTests that can be performed at home are used in blood glucose monitoring for illnesses that have already been diagnosed medically so that these illnesses can be maintained via medication and meal timing. Some of the home testing methods include\n\nfingerprick type of glucose meter\ncontinuous glucose monitor\nLaboratory tests are often used to diagnose illnesses and such methods include\n\nfasting blood sugar (FBS), fasting plasma glucose (FPG): 10\u201316 hours after eating[1]\nglucose tolerance test:[2] continuous testing\npostprandial glucose test (PC): 2 hours after eating[1]\nrandom glucose test\nSome laboratory tests don't measure glucose levels directly from body fluids or tissues, but still indicate elevated blood sugar levels. Such tests measure the levels of glycated hemoglobin, other glycated proteins, 1,5-anhydroglucitol etc. from blood.[1]\n\nUse in medical diagnosis \nMain articles: Hyperglycemia \u00a7 Causes, and List of causes of hypoglycemia\nGlucose testing can be used to diagnose or indicate certain medical conditions.\nHigh blood sugar may indicate\n\ngestational diabetes. This temporary form of diabetes appears during pregnancy, and with glucose-controlling medication or insulin symptoms can be improved.[3]\ntype 1 and type 2 diabetes or prediabetes. If diagnosed with diabetes, regular glucose tests can help manage or maintain conditions. Type 1, is commonly seen in children or teenagers whose bodies are not producing enough insulin. Type 2 diabetes, is typically seen in adults who are overweight. The insulin in their bodies are either not working normally, or there is not being enough produced.[4]\npancreatic cancer[4]\npancreatitis[4]\nunderactive thyroid[4]\nLow blood sugar may indicate\n\ninsulin overuse[4]\nstarvation[4]\nunderactive thyroid[4]\nAddison's disease[4]\ninsulinoma[4]\nkidney disease[4]\nPreparing for testing \nFasting prior to glucose testing may be required with some test types. Fasting blood sugar test for example requires 10\u201316 hour long period of not eating before the test.[1]\nBlood sugar levels can be affected by some drugs and prior to some glucose tests these medications should be temporarily given up or their dosages should be decreased. Such drugs may include salicylates (Aspirin), birth control pills, corticosteroids, tricyclic antidepressants, lithium, diuretics and phenytoin.[4]\nSome foods contain caffeine (coffee, tea, colas, energy drinks etc.). Blood sugar levels of healthy people are generally not significantly changed by caffeine, but in diabetics caffeine intake may elevate these levels via its ability to stimulate the adrenergic nervous system.[5]\n\nReference ranges \nFasting blood sugar \nA level below 5.6 mmol\/l (100 mg\/dl) 10\u201316 hours without eating is normal. 5.6\u20136 mmol\/l (100\u2013109 mg\/dl) may indicate prediabetes and oral glucose tolerance test (OGTT) should be done for high-risk individuals (old people, those with high blood pressure etc.). 6.1\u20136.9 mmol\/l (110\u2013125 mg\/dl) means OGTT should be done even if other indicators of diabetes are not present. 7 mmol\/l (126 mg\/dl) and above indicates diabetes and the fasting test should be repeated.[6]\n\nGlucose tolerance test \nMain article: Glucose tolerance test \u00a7 Results\nPostprandial glucose test \nMain article: Postprandial_glucose_test \u00a7 Reference_ranges\nRandom glucose test \nMain article: Random glucose test \u00a7 Reference_values\nSee also \nHyperglycemia\nHypoglycemia\nReferences \n\n\n^ a b c d Khatib, Oussama MN (2006). Guidelines for the prevention, management and care of diabetes mellitus. World Health Organization, Regional Office for the Eastern Mediterranean. pp. 30, 37. ISBN 9789290214045. OCLC 76821700. \n\n^ MedlinePlus Encyclopedia Glucose tolerance test \n\n^ \"Is the glucose test during pregnancy optional? - Today's Parent\". Today's Parent. 2017-08-30. Retrieved 2018-05-05 . \n\n^ a b c d e f g h i j k \"Blood Glucose Test: Preparation, Procedure, and More\". Healthline. Retrieved 2018-05-05 . \n\n^ \"How Does Coffee Affect Your Blood Sugar?\". WebMD. Retrieved 2018-08-30 . \n\n^ Diabetes \u2013 tests and diagnosis \n\n\nvteCommon for blood tests (CPT 82000\u201384999)Electrolytes\nSodium\nPotassium\nChloride\nCalcium\nRenal function\nCreatinine\nUrea\nBUN-to-creatinine ratio\nPlasma osmolality\nSerum osmolal gap\nAcid-base\nAnion gap\nArterial blood gas\nBase excess\nBicarbonate\nCO2 content\nIron tests\nFerritin\nSerum iron\nTransferrin saturation\nTotal iron-binding capacity\nTransferrin\nTransferrin receptor\nHormones\nACTH stimulation test\nThyroid function tests\nThyroid-stimulating hormone\nMetabolism\nBlood lipids\nCardiovascular\nCardiac marker\nTroponin test\nCPK-MB test\nLactate dehydrogenase\nMyoglobin\nGlycogen phosphorylase isoenzyme BB\nLiver function tests\nProteins\nHuman serum albumin\nSerum total protein\nALP\ntransaminases\nALT\nAST\nAST\/ALT ratio\nBilirubin\nUnconjugated\nConjugated\nPancreas\nAmylase\nLipase\nPancreatic lipase\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Glucose_test\">https:\/\/www.limswiki.org\/index.php\/Glucose_test<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:38.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 524 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","5ff6b49fb2382d04d168fa8c319633ae_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Glucose_test skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Glucose test<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>Many types of <b>glucose tests<\/b> exist and they can be used to estimate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_sugar_levels\" class=\"mw-redirect\" title=\"Blood sugar levels\" rel=\"external_link\" target=\"_blank\">blood sugar levels<\/a> at a given time or, over a longer period of time, to obtain average levels or to see how fast body is able to normalize changed glucose levels. Eating food for example leads to elevated blood sugar levels. In healthy people these levels quickly return to normal via increased <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cell_(biology)\" title=\"Cell (biology)\" rel=\"external_link\" target=\"_blank\">cellular<\/a> glucose uptake which is primarily mediated by increase in blood <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulin\" title=\"Insulin\" rel=\"external_link\" target=\"_blank\">insulin<\/a> levels.\n<\/p><p>Glucose tests can reveal temporary\/long-term <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperglycemia\" title=\"Hyperglycemia\" rel=\"external_link\" target=\"_blank\">hyperglycemia<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoglycemia\" title=\"Hypoglycemia\" rel=\"external_link\" target=\"_blank\">hypoglycemia<\/a>. These conditions may not have obvious symptoms and can damage organs in the long-term. Abnormally high\/low levels, slow return to normal levels from either of these conditions and\/or inability to normalize blood sugar levels means that the person being tested probably has some kind of medical condition like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Type_2_diabetes\" class=\"mw-redirect\" title=\"Type 2 diabetes\" rel=\"external_link\" target=\"_blank\">type 2 diabetes<\/a> which is caused by cellular insensitivity to insulin. Glucose tests are thus often used to diagnose such conditions.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Testing_methods\">Testing methods<\/span><\/h2>\n<p>Tests that can be performed at home are used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_glucose_monitoring\" title=\"Blood glucose monitoring\" rel=\"external_link\" target=\"_blank\">blood glucose monitoring<\/a> for illnesses that have already been diagnosed medically so that these illnesses can be maintained via medication and meal timing. Some of the home testing methods include\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fingerprick\" class=\"mw-redirect\" title=\"Fingerprick\" rel=\"external_link\" target=\"_blank\">fingerprick<\/a> type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose_meter\" title=\"Glucose meter\" rel=\"external_link\" target=\"_blank\">glucose meter<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Continuous_glucose_monitor\" title=\"Continuous glucose monitor\" rel=\"external_link\" target=\"_blank\">continuous glucose monitor<\/a><\/li><\/ul>\n<p>Laboratory tests are often used to diagnose illnesses and such methods include\n<\/p>\n<ul><li>fasting blood sugar (FBS), fasting plasma glucose (FPG): 10\u201316 hours after eating<sup id=\"rdp-ebb-cite_ref-:1_1-0\" class=\"reference\"><a href=\"#cite_note-:1-1\" rel=\"external_link\">[1]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose_tolerance_test\" title=\"Glucose tolerance test\" rel=\"external_link\" target=\"_blank\">glucose tolerance test<\/a>:<sup id=\"rdp-ebb-cite_ref-Medline-GTT_2-0\" class=\"reference\"><a href=\"#cite_note-Medline-GTT-2\" rel=\"external_link\">[2]<\/a><\/sup> continuous testing<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Postprandial_glucose_test\" title=\"Postprandial glucose test\" rel=\"external_link\" target=\"_blank\">postprandial glucose test<\/a> (PC): 2 hours after eating<sup id=\"rdp-ebb-cite_ref-:1_1-1\" class=\"reference\"><a href=\"#cite_note-:1-1\" rel=\"external_link\">[1]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Random_glucose_test\" title=\"Random glucose test\" rel=\"external_link\" target=\"_blank\">random glucose test<\/a><\/li><\/ul>\n<p>Some laboratory tests don't measure glucose levels directly from body fluids or tissues, but still indicate elevated blood sugar levels. Such tests measure the levels of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glycated_hemoglobin\" title=\"Glycated hemoglobin\" rel=\"external_link\" target=\"_blank\">glycated hemoglobin<\/a>, other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glycation\" title=\"Glycation\" rel=\"external_link\" target=\"_blank\">glycated<\/a> proteins, <a href=\"https:\/\/en.wikipedia.org\/wiki\/1,5-anhydroglucitol\" class=\"mw-redirect\" title=\"1,5-anhydroglucitol\" rel=\"external_link\" target=\"_blank\">1,5-anhydroglucitol<\/a> etc. from blood.<sup id=\"rdp-ebb-cite_ref-:1_1-2\" class=\"reference\"><a href=\"#cite_note-:1-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Use_in_medical_diagnosis\">Use in medical diagnosis<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main articles: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperglycemia#Causes\" title=\"Hyperglycemia\" rel=\"external_link\" target=\"_blank\">Hyperglycemia \u00a7 Causes<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_causes_of_hypoglycemia\" title=\"List of causes of hypoglycemia\" rel=\"external_link\" target=\"_blank\">List of causes of hypoglycemia<\/a><\/div>\n<p>Glucose testing can be used to diagnose or indicate certain medical conditions.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/High_blood_sugar\" class=\"mw-redirect\" title=\"High blood sugar\" rel=\"external_link\" target=\"_blank\">High blood sugar<\/a> may indicate\n<\/p>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Gestational_diabetes\" title=\"Gestational diabetes\" rel=\"external_link\" target=\"_blank\">gestational diabetes<\/a>. This temporary form of diabetes appears during pregnancy, and with glucose-controlling medication or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulin\" title=\"Insulin\" rel=\"external_link\" target=\"_blank\">insulin<\/a> symptoms can be improved.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetes_mellitus_type_1\" title=\"Diabetes mellitus type 1\" rel=\"external_link\" target=\"_blank\">type 1<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Type_2_diabetes\" class=\"mw-redirect\" title=\"Type 2 diabetes\" rel=\"external_link\" target=\"_blank\">type 2 diabetes<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prediabetes\" title=\"Prediabetes\" rel=\"external_link\" target=\"_blank\">prediabetes<\/a>. If diagnosed with diabetes, regular glucose tests can help manage or maintain conditions. Type 1, is commonly seen in children or teenagers whose bodies are not producing enough insulin. Type 2 diabetes, is typically seen in adults who are overweight. The insulin in their bodies are either not working normally, or there is not being enough produced.<sup id=\"rdp-ebb-cite_ref-:0_4-0\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pancreatic_cancer\" title=\"Pancreatic cancer\" rel=\"external_link\" target=\"_blank\">pancreatic cancer<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-1\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Pancreatitis\" title=\"Pancreatitis\" rel=\"external_link\" target=\"_blank\">pancreatitis<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-2\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Underactive_thyroid\" class=\"mw-redirect\" title=\"Underactive thyroid\" rel=\"external_link\" target=\"_blank\">underactive thyroid<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-3\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li><\/ul>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Low_blood_sugar\" class=\"mw-redirect\" title=\"Low blood sugar\" rel=\"external_link\" target=\"_blank\">Low blood sugar<\/a> may indicate\n<\/p>\n<ul><li>insulin overuse<sup id=\"rdp-ebb-cite_ref-:0_4-4\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Starvation\" title=\"Starvation\" rel=\"external_link\" target=\"_blank\">starvation<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-5\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Underactive_thyroid\" class=\"mw-redirect\" title=\"Underactive thyroid\" rel=\"external_link\" target=\"_blank\">underactive thyroid<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-6\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Addison%27s_disease\" title=\"Addison's disease\" rel=\"external_link\" target=\"_blank\">Addison's disease<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-7\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Insulinoma\" title=\"Insulinoma\" rel=\"external_link\" target=\"_blank\">insulinoma<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-8\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_disease\" title=\"Kidney disease\" rel=\"external_link\" target=\"_blank\">kidney disease<\/a><sup id=\"rdp-ebb-cite_ref-:0_4-9\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Preparing_for_testing\">Preparing for testing<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fasting\" title=\"Fasting\" rel=\"external_link\" target=\"_blank\">Fasting<\/a> prior to glucose testing may be required with some test types. Fasting blood sugar test for example requires 10\u201316 hour long period of not eating before the test.<sup id=\"rdp-ebb-cite_ref-:1_1-3\" class=\"reference\"><a href=\"#cite_note-:1-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>Blood sugar levels can be affected by some drugs and prior to some glucose tests these medications should be temporarily given up or their dosages should be decreased. Such drugs may include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Salicylates\" class=\"mw-redirect\" title=\"Salicylates\" rel=\"external_link\" target=\"_blank\">salicylates<\/a> (Aspirin), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Birth_control_pills\" class=\"mw-redirect\" title=\"Birth control pills\" rel=\"external_link\" target=\"_blank\">birth control pills<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corticosteroids\" class=\"mw-redirect\" title=\"Corticosteroids\" rel=\"external_link\" target=\"_blank\">corticosteroids<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tricyclic_antidepressants\" class=\"mw-redirect\" title=\"Tricyclic antidepressants\" rel=\"external_link\" target=\"_blank\">tricyclic antidepressants<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithium_(medication)\" title=\"Lithium (medication)\" rel=\"external_link\" target=\"_blank\">lithium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diuretics\" class=\"mw-redirect\" title=\"Diuretics\" rel=\"external_link\" target=\"_blank\">diuretics<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phenytoin\" title=\"Phenytoin\" rel=\"external_link\" target=\"_blank\">phenytoin<\/a>.<sup id=\"rdp-ebb-cite_ref-:0_4-10\" class=\"reference\"><a href=\"#cite_note-:0-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p><p>Some foods contain <a href=\"https:\/\/en.wikipedia.org\/wiki\/Caffeine\" title=\"Caffeine\" rel=\"external_link\" target=\"_blank\">caffeine<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Coffee\" title=\"Coffee\" rel=\"external_link\" target=\"_blank\">coffee<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tea\" title=\"Tea\" rel=\"external_link\" target=\"_blank\">tea<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cola\" title=\"Cola\" rel=\"external_link\" target=\"_blank\">colas<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Energy_drink\" title=\"Energy drink\" rel=\"external_link\" target=\"_blank\">energy drinks<\/a> etc.). Blood sugar levels of healthy people are generally not significantly changed by caffeine, but in diabetics caffeine intake may elevate these levels via its ability to stimulate the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Adrenergic_nervous_system\" title=\"Adrenergic nervous system\" rel=\"external_link\" target=\"_blank\">adrenergic nervous system<\/a>.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Reference_ranges\">Reference ranges<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Fasting_blood_sugar\">Fasting blood sugar<\/span><\/h3>\n<p>A level below 5.6 mmol\/l (100 mg\/dl) 10\u201316 hours without eating is normal. 5.6\u20136 mmol\/l (100\u2013109 mg\/dl) may indicate <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prediabetes\" title=\"Prediabetes\" rel=\"external_link\" target=\"_blank\">prediabetes<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oral_glucose_tolerance_test\" class=\"mw-redirect\" title=\"Oral glucose tolerance test\" rel=\"external_link\" target=\"_blank\">oral glucose tolerance test<\/a> (OGTT) should be done for high-risk individuals (old people, those with <a href=\"https:\/\/en.wikipedia.org\/wiki\/High_blood_pressure\" class=\"mw-redirect\" title=\"High blood pressure\" rel=\"external_link\" target=\"_blank\">high blood pressure<\/a> etc.). 6.1\u20136.9 mmol\/l (110\u2013125 mg\/dl) means OGTT should be done even if other indicators of diabetes are not present. 7 mmol\/l (126 mg\/dl) and above indicates diabetes and the fasting test should be repeated.<sup id=\"rdp-ebb-cite_ref-Diabetes_6-0\" class=\"reference\"><a href=\"#cite_note-Diabetes-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Glucose_tolerance_test\">Glucose tolerance test<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose_tolerance_test#Results\" title=\"Glucose tolerance test\" rel=\"external_link\" target=\"_blank\">Glucose tolerance test \u00a7 Results<\/a><\/div>\n<h3><span class=\"mw-headline\" id=\"Postprandial_glucose_test\">Postprandial glucose test<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Postprandial_glucose_test#Reference_ranges\" title=\"Postprandial glucose test\" rel=\"external_link\" target=\"_blank\">Postprandial_glucose_test \u00a7 Reference_ranges<\/a><\/div>\n<h3><span class=\"mw-headline\" id=\"Random_glucose_test\">Random glucose test<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Random_glucose_test#Reference_values\" title=\"Random glucose test\" rel=\"external_link\" target=\"_blank\">Random glucose test \u00a7 Reference_values<\/a><\/div>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperglycemia\" title=\"Hyperglycemia\" rel=\"external_link\" target=\"_blank\">Hyperglycemia<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoglycemia\" title=\"Hypoglycemia\" rel=\"external_link\" target=\"_blank\">Hypoglycemia<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-:1-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:1_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:1_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Khatib, Oussama MN (2006). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/oclc\/76821700\" target=\"_blank\"><i>Guidelines for the prevention, management and care of diabetes mellitus<\/i><\/a>. World Health Organization, Regional Office for the Eastern Mediterranean. pp. 30, 37. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 9789290214045. <a href=\"https:\/\/en.wikipedia.org\/wiki\/OCLC\" title=\"OCLC\" rel=\"external_link\" target=\"_blank\">OCLC<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/oclc\/76821700\" target=\"_blank\">76821700<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Guidelines+for+the+prevention%2C+management+and+care+of+diabetes+mellitus&rft.pages=30%2C+37&rft.pub=World+Health+Organization%2C+Regional+Office+for+the+Eastern+Mediterranean&rft.date=2006&rft_id=info%3Aoclcnum%2F76821700&rft.isbn=9789290214045&rft.aulast=Khatib&rft.aufirst=Oussama+MN&rft_id=https%3A%2F%2Fwww.worldcat.org%2Foclc%2F76821700&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+test\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Medline-GTT-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Medline-GTT_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/MedlinePlus\" title=\"MedlinePlus\" rel=\"external_link\" target=\"_blank\">MedlinePlus Encyclopedia<\/a><\/i> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/medlineplus.gov\/ency\/article\/003466.htm\" target=\"_blank\">Glucose tolerance test<\/a><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.todaysparent.com\/pregnancy\/pregnancy-health\/is-the-glucose-test-during-pregnancy-optional\" target=\"_blank\">\"Is the glucose test during pregnancy optional? - Today's Parent\"<\/a>. <i>Today's Parent<\/i>. 2017-08-30<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-05-05<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Today%27s+Parent&rft.atitle=Is+the+glucose+test+during+pregnancy+optional%3F+-+Today%27s+Parent&rft.date=2017-08-30&rft_id=http%3A%2F%2Fwww.todaysparent.com%2Fpregnancy%2Fpregnancy-health%2Fis-the-glucose-test-during-pregnancy-optional&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-:0-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-4\" rel=\"external_link\"><sup><i><b>e<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-5\" rel=\"external_link\"><sup><i><b>f<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-6\" rel=\"external_link\"><sup><i><b>g<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-7\" rel=\"external_link\"><sup><i><b>h<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-8\" rel=\"external_link\"><sup><i><b>i<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-9\" rel=\"external_link\"><sup><i><b>j<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_4-10\" rel=\"external_link\"><sup><i><b>k<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.healthline.com\/health\/glucose-test-blood\" target=\"_blank\">\"Blood Glucose Test: Preparation, Procedure, and More\"<\/a>. <i>Healthline<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-05-05<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Healthline&rft.atitle=Blood+Glucose+Test%3A+Preparation%2C+Procedure%2C+and+More&rft_id=http%3A%2F%2Fwww.healthline.com%2Fhealth%2Fglucose-test-blood&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.webmd.com\/diabetes\/diabetes-and-caffeine\" target=\"_blank\">\"How Does Coffee Affect Your Blood Sugar?\"<\/a>. <i>WebMD<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2018-08-30<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=WebMD&rft.atitle=How+Does+Coffee+Affect+Your+Blood+Sugar%3F&rft_id=https%3A%2F%2Fwww.webmd.com%2Fdiabetes%2Fdiabetes-and-caffeine&rfr_id=info%3Asid%2Fen.wikipedia.org%3AGlucose+test\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Diabetes-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Diabetes_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mayoclinic.com\/health\/diabetes\/DS01121\/DSECTION=tests-and-diagnosis\" target=\"_blank\">Diabetes \u2013 tests and diagnosis<\/a><\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1333\nCached time: 20181207155807\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.228 seconds\nReal time usage: 0.294 seconds\nPreprocessor visited node count: 689\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 23940\/2097152 bytes\nTemplate argument size: 175\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 13412\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.114\/10.000 seconds\nLua memory usage: 2.98 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 246.340 1 -total\n<\/p>\n<pre>61.00% 150.276 1 Template:Reflist\n44.13% 108.713 1 Template:Cite_book\n16.54% 40.752 1 Template:Infobox_diagnostic\n14.38% 35.421 1 Template:Infobox\n 9.96% 24.526 4 Template:Main\n 6.63% 16.325 1 Template:Blood_tests\n 6.51% 16.043 3 Template:Cite_news\n 4.71% 11.604 1 Template:Navbox\n 1.31% 3.227 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:3012322-1!canonical and timestamp 20181207155806 and revision id 859003814\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Glucose_test\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214700\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.147 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 141.123 1 - wikipedia:Glucose_test\n100.00% 141.123 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8567-0!*!*!*!*!*!* and timestamp 20181217214700 and revision id 24995\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Glucose_test\">https:\/\/www.limswiki.org\/index.php\/Glucose_test<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","5ff6b49fb2382d04d168fa8c319633ae_images":[],"5ff6b49fb2382d04d168fa8c319633ae_timestamp":1545083220,"1511b5ea96046b1f5ee06ec866bbcc44_type":"article","1511b5ea96046b1f5ee06ec866bbcc44_title":"Endoscopy","1511b5ea96046b1f5ee06ec866bbcc44_url":"https:\/\/www.limswiki.org\/index.php\/Endoscopy","1511b5ea96046b1f5ee06ec866bbcc44_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tEndoscopy\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor the notion in mathematics introduced by Langlands, see Endoscopic group.\nThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (January 2016) (Learn how and when to remove this template message)\nEndoscopeAn example of a flexible endoscopeMeSHD004724 OPS-301 code1-40...1-49, 1-61...1-69MedlinePlus003338 [edit on Wikidata]\n A physician training to use an endoscope\nAn endoscopy (looking inside) is used in medicine to look inside the body.[1] The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inserted directly into the organ.\nThere are many types of endoscopes. Depending on the site in the body and type of procedure an endoscopy may be performed either by a doctor or a surgeon. A patient may be fully conscious or anaesthetised during the procedure. Most often the term endoscopy is used to refer to an examination of the upper part of the gastrointestinal tract, known as an esophagogastroduodenoscopy.[2]\nFor non-medical use, similar instruments are called borescopes.\n\nContents \n\n1 History \n2 Medical uses \n\n2.1 Applications \n\n\n3 Application in other fields \n4 Risks \n5 After the endoscopy \n6 Endoscope \n7 History \n\n7.1 Wolf and Storz \n7.2 Fiber optics \n7.3 Rod-lens endoscopes \n7.4 Endoscope reprocessing \n\n\n8 Recent developments \n\n8.1 Endoscopy VR simulators \n8.2 Disposable endoscopy \n8.3 Capsule endoscopy \n8.4 Augmented reality \n8.5 New imaging modalities \n\n\n9 See also \n10 References \n11 External links \n\n\nHistory \nThe self-illuminated endoscope was developed at Glasgow Royal Infirmary in Scotland (one of the first hospitals to have mains electricity) in 1894\/5 by Dr John Macintyre as part of his specialization in investigation of the larynx.[3]\n\nMedical uses \n Operation part of the endoscope\n Insertion tip of endoscope\nA health care provider may use endoscopy for any of the following:\n\ninvestigation of symptoms, such as symptoms in the digestive system including nausea, vomiting, abdominal pain, difficulty swallowing, and gastrointestinal bleeding.[4]\nconfirmation of a diagnosis, most commonly by performing a biopsy to check for conditions such as anemia, bleeding, inflammation, and cancers of the digestive system.[4]\ngiving treatment, such as cauterization of a bleeding vessel, widening a narrow esophagus, clipping off a polyp or removing a foreign object.[4]\nSpecialty professional organizations which specialize in digestive problems advise that many patients with Barrett's esophagus are too frequently receiving endoscopies.[5] Such societies recommend that patients with Barrett's esophagus and no cancer symptoms after two biopsies receive biopsies as indicated and no more often than the recommended rate.[6][7]\n\nApplications \n An anoscope, a proctoscope, and a rectoscope with approximate lengths\n Endoscopy surgery\nHealth care providers can use endoscopy to review any of the following body parts:\n\nThe gastrointestinal tract (GI tract):\n Esophageal Bougie Dilatoroesophagus, stomach and duodenum (esophagogastroduodenoscopy)\nsmall intestine (enteroscopy)\nlarge intestine\/colon (colonoscopy, sigmoidoscopy)\nMagnification endoscopy\nbile duct\nendoscopic retrograde cholangiopancreatography (ERCP), duodenoscope-assisted cholangiopancreatoscopy, intraoperative cholangioscopy\nrectum (rectoscopy) and anus (anoscopy), both also referred to as (proctoscopy)\nThe respiratory tract\nThe nose (rhinoscopy)\nThe lower respiratory tract (bronchoscopy)\nThe ear (otoscope)\nThe urinary tract (cystoscopy)\nThe female reproductive system (gynoscopy)\nThe cervix (colposcopy)\nThe uterus (hysteroscopy)\nThe fallopian tubes (falloposcopy)\nNormally closed body cavities (through a small incision):\nThe abdominal or pelvic cavity (laparoscopy)\nThe interior of a joint (arthroscopy)\nOrgans of the chest (thoracoscopy and mediastinoscopy)\nEndoscopy is used for many procedures:\n\nDuring pregnancy\nThe amnion (amnioscopy)\nThe fetus (fetoscopy)\nPlastic surgery\nPanendoscopy (or triple endoscopy)\nCombines laryngoscopy, esophagoscopy, and bronchoscopy\nOrthopedic surgery\nHand surgery, such as endoscopic carpal tunnel release\nKnee surgery, such as anterior cruciate ligament reconstruction\nEpidural space (Epiduroscopy)\nBursae (Bursectomy)\nEndodontic surgery\nMaxillary sinus surgery\nApicoectomy\nEndoscopic endonasal surgery\nEndoscopic spinal surgery\nAn Endoscopy is a simple procedure which allows a doctor to look inside human bodies using an instrument called an endoscope. A cutting tool can be attached to the end of the endoscope, and the apparatus can then be used to perform surgery. This type of surgery is called Key hole surgery, and usually leaves only a tiny scar externally.\n\nApplication in other fields \nThe planning and architectural community use architectural endoscopy for pre-visualization of scale models of proposed buildings and cities\nInternal inspection of complex technical systems (borescope)\nEndoscopes are also a tool helpful in the examination of improvised explosive devices by bomb disposal personnel.\nThe FBI uses endoscopes for conducting surveillance via tight spaces.\nRisks \nThe main risks are infection, over-sedation, perforation, or a tear of the stomach or esophagus lining and bleeding.[8] Although perforation generally requires surgery, certain cases may be treated with antibiotics and intravenous fluids. Bleeding may occur at the site of a biopsy or polyp removal. Such typically minor bleeding may simply stop on its own or be controlled by cauterisation. Seldom does surgery become necessary. Perforation and bleeding are rare during gastroscopy. Other minor risks include drug reactions and complications related to other diseases the patient may have. Consequently, patients should inform their doctor of all allergic tendencies and medical problems. Occasionally, the site of the sedative injection may become inflamed and tender for a short time. This is usually not serious and warm compresses for a few days are usually helpful. While any of these complications may possibly occur, it is good to remember that each of them occurs quite infrequently. A doctor can further discuss risks with the patient with regard to the particular need for gastroscopy.\n\nAfter the endoscopy \nAfter the procedure, the patient will be observed and monitored by a qualified individual in the endoscopy room, or a recovery area, until a significant portion of the medication has worn off. Occasionally the patient is left with a mild sore throat, which may respond to saline gargles, or chamomile tea. It may last for weeks or not happen at all. The patient may have a feeling of distention from the insufflated air that was used during the procedure. Both problems are mild and fleeting. When fully recovered, the patient will be instructed when to resume their usual diet (probably within a few hours) and will be allowed to be taken home. Where sedation has been used, most facilities mandate that the patient be taken home by another person and that he or she not drive or handle machinery for the remainder of the day. Patients who have had an endoscopy without sedation are able to leave unassisted.\n\nEndoscope \nMain article: Endoscope\nAn endoscope can consist of:\n\na rigid or flexible tube.\na light delivery system to illuminate the organ or object under inspection. The light source is normally outside the body and the light is typically directed via an optical fiber system.\na lens system transmitting the image from the objective lens to the viewer, typically a relay lens system in the case of rigid endoscopes or a bundle of fiberoptics in the case of a fiberscope.\nan eyepiece. Modern instruments may be videoscopes, with no eyepiece. A camera transmits image to a screen for image capture.\nan additional channel to allow entry of medical instruments or manipulators.\nPatients undergoing the procedure may be offered sedation, which includes its own risks.\n\nHistory \n Drawings of Bozzini's \"Lichtleiter\", an early endoscope\nThe first endoscope was developed in 1806 by Philipp Bozzini in Mainz with his introduction of a \"Lichtleiter\" (light conductor) \"for the examinations of the canals and cavities of the human body\".[9] However, the Vienna Medical Society disapproved of such curiosity.[10] The first to use an endoscope in a successful operation was Antonin Jean Desormeaux whose invention was the state of the art before the invention of electricity.[citation needed ]\nThe use of electric light was a major step in the improvement of endoscopy. The first such lights were external although sufficiently capable of illumination to allow cystoscopy, hysteroscopy and sigmoidoscopy as well as examination of the nasal (and later thoracic) cavities as was being performed routinely in human patients by Sir Francis Cruise (using his own commercially available endoscope) by 1865 in the Mater Misericordiae Hospital in Dublin, Ireland.[11] Later, smaller bulbs became available making internal light possible, for instance in a hysteroscope by Charles David in 1908.[12]\nHans Christian Jacobaeus has been given credit for the first large published series of endoscopic explorations of the abdomen and the thorax with laparoscopy (1912) and thoracoscopy (1910)[13] although the first reported thoracoscopic examination in a human was also by Cruise.[14]\nLaparoscopy was used in the diagnosis of liver and gallbladder disease by Heinz Kalk in the 1930s.[15] Hope reported in 1937 on the use of laparoscopy to diagnose ectopic pregnancy.[16] In 1944, Raoul Palmer placed his patients in the Trendelenburg position after gaseous distention of the abdomen and thus was able to reliably perform gynecologic laparoscopy.[17]\n\nWolf and Storz \nGeorg Wolf (1873\u20131938) a Berlin manufacturer of rigid endoscopes, established in 1906, produced the Sussmann flexible gastroscope in 1911 (Modlin, Farhadi-Journal of Clinical Gastroenterology, 2000).[18] Karl Storz began producing instruments for ENT specialists in 1945 through his company, Karl Storz GmbH.[19]\n\nFiber optics \n A Storz endoscopy unit used for laryngoscopy exams of the vocal folds and the glottis\nBasil Hirschowitz and Larry Curtiss invented the first fiber optic endoscope in 1957.[20] Earlier in the 1950s Harold Hopkins had designed a \"fibroscope\" consisting of a bundle of flexible glass fibres able to coherently transmit an image. This proved useful both medically and industrially, and subsequent research led to further improvements in image quality. Further innovations included using additional fibres to channel light to the objective end from a powerful external source, thereby achieving the high level of full spectrum illumination that was needed for detailed viewing, and colour photography.[citation needed ]\nThe previous practice of a small filament lamp on the tip of the endoscope had left the choice of either viewing in a dim red light or increasing the light output - which carried the risk of burning the inside of the patient. Alongside the advances to the optics, the ability to 'steer' the tip was developed, as well as innovations in remotely operated surgical instruments contained within the body of the endoscope itself. This was the beginning of \"key-hole surgery\" as we know it today.[citation needed ]\n\nRod-lens endoscopes \nThere were physical limits to the image quality of a fibroscope. A bundle of say 50,000 fibers gives effectively only a 50,000-pixel image, and continued flexing from use breaks fibers and so progressively loses pixels. Eventually so many are lost that the whole bundle must be replaced (at considerable expense). Harold Hopkins realised that any further optical improvement would require a different approach. Previous rigid endoscopes suffered from low light transmittance and poor image quality. The surgical requirement of passing surgical tools as well as the illumination system within the endoscope's tube - which itself is limited in dimensions by the human body - left very little room for the imaging optics. The tiny lenses of a conventional system required supporting rings that would obscure the bulk of the lens area; they were difficult to manufacture and assemble and optically nearly useless.[citation needed ]\nThe elegant solution that Hopkins invented was to fill the air-spaces between the 'little lenses' with rods of glass. These fitted exactly the endoscope's tube, making them self-aligning, and required no other support. This allowed the little lenses to be dispensed with altogether. The rod-lenses were much easier to handle and used the maximum possible diameter available.[citation needed ]\nWith the appropriate curvature and coatings to the rod ends and optimal choices of glass-types, all calculated and specified by Hopkins, the image quality was transformed - even with tubes of only 1mm in diameter. With a high quality 'telescope' of such small diameter the tools and illumination system could be comfortably housed within an outer tube. Once again it was Karl Storz who produced the first of these new endoscopes as part of a long and productive partnership between the two men.[21]\nWhilst there are regions of the body that will always require flexible endoscopes (principally the gastrointestinal tract), the rigid rod-lens endoscopes have such exceptional performance that they are still the preferred instrument and have enabled modern key-hole surgery. (Harold Hopkins was recognized and honoured for his advancement of medical-optic by the medical community worldwide. It formed a major part of the citation when he was awarded the Rumford Medal by the Royal Society in 1984.)\nBy measuring absorption of light by the blood (by passing the light through one fibre and collecting the light through another fibre) a doctor can estimate the proportion of haemoglobin in the blood and diagnose ulceration in the stomach.[citation needed ]\n\nEndoscope reprocessing \nHigh level disinfection of flexible endoscopes is required by all national guideline issuing bodies.[22] The high level disinfection of endoscopes occurs during a multi-step process called reprocessing. Reprocessing endoscopes involves over 100 individuals steps.[23] These steps can be broken down into broad categories of pre-cleaning, leak testing, manual cleaning, cleaning verification, visual inspection, high level disinfection, rinsing, drying, and storage.[24] Failure to perform all of these steps correctly can lead to residual contamination remaining on endoscopes.\nIn the UK, stringent guidelines exist regarding the decontamination and disinfection of flexible endoscopes, the most recent being CfPP 01\u201306, released in 2013[25]\nRigid endoscopes, such as an Arthroscope, can be sterilized in the same way as surgical instruments, whereas heat labile flexible endoscopes cannot.[26]\n\nRecent developments \n Low-cost waterproof USB endoscope for non-medical use.\nWith the application of robotic systems, telesurgery was introduced as the surgeon could be at a site far removed from the patient. The first transatlantic surgery has been called the Lindbergh Operation.[citation needed ]\nWireless oesophageal pH measuring devices can now be placed endoscopically, to record ph trends in an area remotely.[citation needed ]\n\nEndoscopy VR simulators \nVirtual reality simulators are being developed for training doctors on various endoscopy skills.[27]\n\nDisposable endoscopy \nDisposable endoscopy is an emerging category of endoscopic instruments. Recent developments[28] have allowed the manufacture of endoscopes inexpensive enough to be used on a single patient only. It is meeting a growing demand to lessen the risk of cross contamination and hospital acquired diseases. A European consortium of the SME are working on the DUET (disposable use of endoscopy tool) project to build a disposable endoscope.[29]\n\nCapsule endoscopy \nMain article: Capsule endoscopy\nCapsule endoscopes are pill-sized imaging devices that are swallowed by a patient and then record images of the gastrointestinal tract as they pass through naturally. Images are typically retrieved via wireless data transfer to an external receiver.\n\nAugmented reality \nThe endoscopic image can be combined with other image sources to provide the surgeon with additional information. For instance, the position of an anatomical structure or tumor might be shown in the endoscopic video.[30]\n\nNew imaging modalities \nEmerging endoscope technologies measure additional properties of light to improve contrast, such as optical polarization,[31] optical phase, [32] and additional wavelengths of light (hyperspectral endoscopy).[33]\n\nSee also \n Endoscopy portal\nReferences \n\n\n^ \"Endoscopy\". British Medical Association Complete Family Health Encyclopedia. Dorling Kindersley Limited. 1990. \n\n^ \"Endoscopy\". Cancer Research UK. Retrieved 5 November 2015 . \n\n^ \"The Scottish Society of the History of Medicine\" (PDF) . \n\n^ a b c Staff (2012). \"Upper endoscopy\". Mayo Clinic. Retrieved 24 September 2012 . \n\n^ American Gastroenterological Association, \"Five Things Physicians and Patients Should Question\" (PDF) , Choosing Wisely: an initiative of the ABIM Foundation, American Gastroenterological Association, archived from the original (PDF) on August 9, 2012, retrieved August 17, 2012 \n\n^ Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ (March 2011). \"American Gastroenterological Association medical position statement on the management of Barrett's esophagus\". Gastroenterology. 140 (3): 1084\u201391. doi:10.1053\/j.gastro.2011.01.030. PMID 21376940. \n\n^ Wang KK, Sampliner RE (March 2008). \"Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus\". The American Journal of Gastroenterology. 103 (3): 788\u201397. doi:10.1111\/j.1572-0241.2008.01835.x. PMID 18341497. \n\n^ \"Endoscopy\". NHS Choices. NHS Gov.UK. Retrieved April 20, 2017 . \n\n^ Bozzini, Philipp (1806). \"Lichtleiter, eine Erfindung zur Anschauung innerer Teile und Krankheiten, nebst der Abbildung\" [Light conductor, an invention for examining internal parts and diseases, together with illustrations]. Journal der practischen Arzneykunde und Wundarzneykunst (in German). 24: 107\u201324. \n\n^ Yamada T (2009-01-22). Atlas of Gastroenterology. John Wiley & Sons. ISBN 978-1-4443-0342-1. \n\n^ Caniggia A, Nuti R, Lore F, Martini G, Turchetti V, Righi G (April 1990). \"Long-term treatment with calcitriol in postmenopausal osteoporosis\". Metabolism. 39 (4 Suppl 1): 43\u20139. doi:10.1136\/bmj.1.223.345. JSTOR 25204557. PMC 2325571 . \n\n^ Shawki O, Deshmukh S, Pacheco LA (2017). Mastering the Techniques in Hysteroscopy. Jaypee Brothers Medical Publishers. pp. 13\u2013. ISBN 978-93-86150-49-3. \n\n^ Litynski GS (1997). \"Laparoscopy--the early attempts: spotlighting Georg Kelling and Hans Christian Jacobaeus\". Jsls. 1 (1): 83\u20135. PMC 3015224 . PMID 9876654. \n\n^ Gordon S (2014). \"Art. VIII.\u2014Clinical reports of rare cases, occurring in the Whitworth and Hardwicke Hospitals\". Dublin Quarterly Journal of Medical Science. 41 (1): 83\u201399. doi:10.1007\/BF02946459. \n\n^ Wildhirt E, Kalk H (1977). Neue Deutsche Biographie (NDB). Band 11. Berlin: Duncker & Humblot. p. 60. ISBN 978-3-428-00192-7. \n\n^ Balen AH, Creighton SM, Davies MC, MacDougall J, Stanhope R (2004-04-01). Paediatric and Adolescent Gynaecology: A Multidisciplinary Approach. Cambridge University Press. pp. 131\u2013. ISBN 978-1-107-32018-5. \n\n^ Litynski GS (1997). \"Raoul Palmer, World War II, and transabdominal coelioscopy. Laparoscopy extends into gynecology\". Journal of the Society of Laparoendoscopic Surgeons. 1 (3): 289\u201392. PMC 3016739 . PMID 9876691. \n\n^ \"About Richard Wolf Germany\". Richard Wolf Medical Instruments. \n\n^ Nezhat C (2005). \"Chapter 19. 1960's\". Nezhat's History of Endoscopy. Society of Laparoendoscopic Surgeons. \n\n^ Edmonson JM (1991). \"History of the instruments for gastrointestinal endoscopy\". Gastrointestinal Endoscopy. 37 (2 Suppl): S27\u201356. doi:10.1016\/S0016-5107(91)70910-3. PMID 2044933. \n\n^ \"History\". Harold Hopkins Society. \n\n^ Ofstead CL, Wetzler HP, Heymann OL, Johnson EA, Eiland JE, Shaw MJ (February 2017). \"Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes: Results of visual inspections, biochemical markers, and microbial cultures\". American Journal of Infection Control. 45 (2): e26\u2013e33. doi:10.1016\/j.ajic.2016.10.017. PMID 28159069. \n\n^ Ofstead CL, Wetzler HP, Snyder AK, Horton RA (2010). \"Endoscope reprocessing methods: a prospective study on the impact of human factors and automation\". Gastroenterology Nursing. 33 (4): 304\u201311. doi:10.1097\/SGA.0b013e3181e9431a. PMID 20679783. \n\n^ Herrin A, Loyola M, Bocian S, Diskey A, Friis CM, Herron-Rice L, Juan MR, Schmelzer M, Selking S (2016). \"Standards of Infection Prevention in Reprocessing Flexible Gastrointestinal Endoscopes\". Gastroenterology Nursing. 39 (5): 404\u201318. doi:10.1097\/SGA.0000000000000266. PMID 27684640. \n\n^ \"Health Technical Memorandum 01-06: Decontamination of exible endoscopes Part C: Operational management\" (PDF) . United Kingdom Department of Health. March 2016. \n\n^ Sabnis RB, Bhattu A, Vijaykumar M (March 2014). \"Sterilization of endoscopic instruments\". Current Opinion in Urology. 24 (2): 195\u2013202. doi:10.1097\/MOU.0000000000000034. PMID 24451088. \n\n^ \"Overview of Endoscopy Haptics Simulator Project\". M2D2 Laboratory, Indian Institute of Science. YouTube. \n\n^ \"Dokument nicht gefunden\". Archived from the original on 2011-07-20. \n\n^ \"Development of a Disposable Use Endoscopy Tool\". Archived from the original on 2011-07-23. \n\n^ Augmented Reality: Path guidance to craniopharyngioma on YouTube \n\n^ Manhas S, Vizet J, Deby S, Vanel JC, Boito P, Verdier M, De Martino A, Pagnoux D (February 2015). \"Demonstration of full 4\u00d74 Mueller polarimetry through an optical fiber for endoscopic applications\". Optics Express. 23 (3): 3047\u201354. Bibcode:2015OExpr..23.3047M. doi:10.1364\/OE.23.003047. PMID 25836165. \n\n^ Gordon, GSD; Joseph, J; Alcolea, MP; Sawyer, T; Macfaden, AJ; Williams, C; Fitzpatrick, CRM; Jones, PH; di Pietro, M; Fitzgerald, RC; Wilkinson, TD; Bohndiek, SE. \"Quantitative phase and polarisation endoscopy applied to detection of early oesophageal tumourigenesis\". arXiv:1811.03977 . \n\n^ Kester RT, Bedard N, Gao L, Tkaczyk TS (May 2011). \"Real-time snapshot hyperspectral imaging endoscope\". Journal of Biomedical Optics. 16 (5): 056005. Bibcode:2011JBO....16e6005K. doi:10.1117\/1.3574756. PMC 3107836 . PMID 21639573. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Endoscopy.\nThe Atlas of Gastrointestinal Endoscopy endoatlas.com\nEl Salvador Atlas of Gastrointestinal Endoscopy\nGastrolab: Site in English, Swedish and Finnish with gastrointestinal endoscopy photolibrary\nPreventing cross-contamination from flexible endoscopes massdevice.com\nAdvances in Endoscopy advancedimagingpro.com\nvteEndoscopyGastrointestinal tract\nUpper:\nEsophagogastroduodenoscopy\nLower: Enteroscopy\nColonoscopy\nSigmoidoscopy\nProctoscopy\nAnoscopy\nCapsule endoscopy\nAccessory: Endoscopic retrograde cholangiopancreatography\nRespiratory tract\nRhinoscopy\nLaryngoscopy\nBronchoscopy\nUrinary tract\nNephroscopy\nUreteroscopy\nCystoscopy\nFemale reproductive system\nColposcopy\nHysteroscopy\nFalloposcopy\nCuldoscopy\nClosed cavity via incision\nLaparoscopy\nLaparoscopic surgery\nArthroscopy\nThoracoscopy\nMediastinoscopy\nCoelioscopy\nOther\nFetoscopy\nAngioscopy\nOtoscopy\n\nAuthority 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:37.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 924 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","1511b5ea96046b1f5ee06ec866bbcc44_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Endoscopy skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Endoscopy<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For the notion in mathematics introduced by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_Langlands\" title=\"Robert Langlands\" rel=\"external_link\" target=\"_blank\">Langlands<\/a>, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopic_group\" title=\"Endoscopic group\" rel=\"external_link\" target=\"_blank\">Endoscopic group<\/a>.<\/div>\n\n\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Santiagodechile2007.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/29\/Santiagodechile2007.jpg\/220px-Santiagodechile2007.jpg\" width=\"220\" height=\"300\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Santiagodechile2007.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A physician training to use an endoscope<\/div><\/div><\/div>\n<p>An <i><b>endoscopy<\/b><\/i> (<i>looking inside<\/i>) is used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a> to look inside the body.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> The endoscopy procedure uses an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\">endoscope<\/a> to examine the interior of a hollow organ or cavity of the body. Unlike many other <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_imaging\" title=\"Medical imaging\" rel=\"external_link\" target=\"_blank\">medical imaging<\/a> techniques, endoscopes are inserted directly into the organ.\n<\/p><p>There are many types of endoscopes. Depending on the site in the body and type of procedure an endoscopy may be performed either by a doctor or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgeon\" title=\"Surgeon\" rel=\"external_link\" target=\"_blank\">surgeon<\/a>. A patient may be fully conscious or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anaesthesia\" class=\"mw-redirect\" title=\"Anaesthesia\" rel=\"external_link\" target=\"_blank\">anaesthetised<\/a> during the procedure. Most often the term <i>endoscopy<\/i> is used to refer to an examination of the upper part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_gastrointestinal_tract\" class=\"mw-redirect\" title=\"Human gastrointestinal tract\" rel=\"external_link\" target=\"_blank\">gastrointestinal tract<\/a>, known as an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophagogastroduodenoscopy\" title=\"Esophagogastroduodenoscopy\" rel=\"external_link\" target=\"_blank\">esophagogastroduodenoscopy<\/a>.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>For non-medical use, similar instruments are called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Borescope\" title=\"Borescope\" rel=\"external_link\" target=\"_blank\">borescopes<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The self-illuminated endoscope was developed at <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glasgow_Royal_Infirmary\" title=\"Glasgow Royal Infirmary\" rel=\"external_link\" target=\"_blank\">Glasgow Royal Infirmary<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scotland\" title=\"Scotland\" rel=\"external_link\" target=\"_blank\">Scotland<\/a> (one of the first hospitals to have mains electricity) in 1894\/5 by Dr <a href=\"https:\/\/en.wikipedia.org\/wiki\/John_Macintyre\" title=\"John Macintyre\" rel=\"external_link\" target=\"_blank\">John Macintyre<\/a> as part of his specialization in investigation of the larynx.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Medical_uses\">Medical uses<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PENTAX_Colonoscope002.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/PENTAX_Colonoscope002.jpg\/220px-PENTAX_Colonoscope002.jpg\" width=\"220\" height=\"172\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:PENTAX_Colonoscope002.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Operation part of the endoscope<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Insertion_tip_of_endoscope.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/86\/Insertion_tip_of_endoscope.jpg\/220px-Insertion_tip_of_endoscope.jpg\" width=\"220\" height=\"160\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Insertion_tip_of_endoscope.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Insertion tip of endoscope<\/div><\/div><\/div>\n<p>A health care provider may use <i><b>endoscopy<\/b><\/i> for any of the following:\n<\/p>\n<ul><li>investigation of symptoms, such as symptoms in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digestive_system\" class=\"mw-redirect\" title=\"Digestive system\" rel=\"external_link\" target=\"_blank\">digestive system<\/a> including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nausea\" title=\"Nausea\" rel=\"external_link\" target=\"_blank\">nausea<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vomiting\" title=\"Vomiting\" rel=\"external_link\" target=\"_blank\">vomiting<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominal_pain\" title=\"Abdominal pain\" rel=\"external_link\" target=\"_blank\">abdominal pain<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Difficulty_swallowing\" class=\"mw-redirect\" title=\"Difficulty swallowing\" rel=\"external_link\" target=\"_blank\">difficulty swallowing<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastrointestinal_bleeding\" title=\"Gastrointestinal bleeding\" rel=\"external_link\" target=\"_blank\">gastrointestinal bleeding<\/a>.<sup id=\"rdp-ebb-cite_ref-mayoendo_4-0\" class=\"reference\"><a href=\"#cite_note-mayoendo-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li>confirmation of a diagnosis, most commonly by performing a biopsy to check for conditions such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anemia\" title=\"Anemia\" rel=\"external_link\" target=\"_blank\">anemia<\/a>, bleeding, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inflammation\" title=\"Inflammation\" rel=\"external_link\" target=\"_blank\">inflammation<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digestive_system_neoplasm\" title=\"Digestive system neoplasm\" rel=\"external_link\" target=\"_blank\">cancers of the digestive system<\/a>.<sup id=\"rdp-ebb-cite_ref-mayoendo_4-1\" class=\"reference\"><a href=\"#cite_note-mayoendo-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li>giving treatment, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cauterization\" title=\"Cauterization\" rel=\"external_link\" target=\"_blank\">cauterization<\/a> of a bleeding vessel, widening a narrow esophagus, clipping off a polyp or removing a foreign object.<sup id=\"rdp-ebb-cite_ref-mayoendo_4-2\" class=\"reference\"><a href=\"#cite_note-mayoendo-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li><\/ul>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Specialty_(medicine)\" title=\"Specialty (medicine)\" rel=\"external_link\" target=\"_blank\">Specialty<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Professional_organizations\" class=\"mw-redirect\" title=\"Professional organizations\" rel=\"external_link\" target=\"_blank\">professional organizations<\/a> which specialize in digestive problems advise that many patients with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Barrett%27s_esophagus\" title=\"Barrett's esophagus\" rel=\"external_link\" target=\"_blank\">Barrett's esophagus<\/a> are too frequently receiving endoscopies.<sup id=\"rdp-ebb-cite_ref-AGAfive_5-0\" class=\"reference\"><a href=\"#cite_note-AGAfive-5\" rel=\"external_link\">[5]<\/a><\/sup> Such societies recommend that patients with Barrett's esophagus and no cancer symptoms after two biopsies receive biopsies as indicated and no more often than the recommended rate.<sup id=\"rdp-ebb-cite_ref-pmid21376940_6-0\" class=\"reference\"><a href=\"#cite_note-pmid21376940-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-pmid18341497_7-0\" class=\"reference\"><a href=\"#cite_note-pmid18341497-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Anoscope,_proctoscope_and_rectoscope.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0e\/Anoscope%2C_proctoscope_and_rectoscope.svg\/250px-Anoscope%2C_proctoscope_and_rectoscope.svg.png\" width=\"250\" height=\"149\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Anoscope,_proctoscope_and_rectoscope.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>An <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anoscope\" class=\"mw-redirect\" title=\"Anoscope\" rel=\"external_link\" target=\"_blank\">anoscope<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Proctoscope\" class=\"mw-redirect\" title=\"Proctoscope\" rel=\"external_link\" target=\"_blank\">proctoscope<\/a>, and a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rectoscope\" class=\"mw-redirect\" title=\"Rectoscope\" rel=\"external_link\" target=\"_blank\">rectoscope<\/a> with approximate lengths<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:US_Navy_081117-N-7526R-568_Cmdr._Thomas_Nelson_and_Lt._Robert_Roadfuss_discuss_proper_procedures_while_performing_a_laparoscopic_cholecystectomy_surgery.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b3\/US_Navy_081117-N-7526R-568_Cmdr._Thomas_Nelson_and_Lt._Robert_Roadfuss_discuss_proper_procedures_while_performing_a_laparoscopic_cholecystectomy_surgery.jpg\/250px-US_Navy_081117-N-7526R-568_Cmdr._Thomas_Nelson_and_Lt._Robert_Roadfuss_discuss_proper_procedures_while_performing_a_laparoscopic_cholecystectomy_surgery.jpg\" width=\"250\" height=\"166\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:US_Navy_081117-N-7526R-568_Cmdr._Thomas_Nelson_and_Lt._Robert_Roadfuss_discuss_proper_procedures_while_performing_a_laparoscopic_cholecystectomy_surgery.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Endoscopy surgery<\/div><\/div><\/div>\n<p>Health care providers can use endoscopy to review any of the following body parts:\n<\/p>\n<ul><li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_gastrointestinal_tract\" class=\"mw-redirect\" title=\"Human gastrointestinal tract\" rel=\"external_link\" target=\"_blank\">gastrointestinal tract<\/a> (GI tract):\n<ul><li><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Esophageal_Bougie_Dilator.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7e\/Esophageal_Bougie_Dilator.jpg\/220px-Esophageal_Bougie_Dilator.jpg\" width=\"220\" height=\"293\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Esophageal_Bougie_Dilator.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Esophageal Bougie Dilator<\/div><\/div><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Oesophagus\" class=\"mw-redirect\" title=\"Oesophagus\" rel=\"external_link\" target=\"_blank\">oesophagus<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stomach\" title=\"Stomach\" rel=\"external_link\" target=\"_blank\">stomach<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Duodenum\" title=\"Duodenum\" rel=\"external_link\" target=\"_blank\">duodenum<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophagogastroduodenoscopy\" title=\"Esophagogastroduodenoscopy\" rel=\"external_link\" target=\"_blank\">esophagogastroduodenoscopy<\/a>)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Small_intestine\" title=\"Small intestine\" rel=\"external_link\" target=\"_blank\">small intestine<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Enteroscopy\" title=\"Enteroscopy\" rel=\"external_link\" target=\"_blank\">enteroscopy<\/a>)<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Large_intestine\" title=\"Large intestine\" rel=\"external_link\" target=\"_blank\">large intestine<\/a>\/<a href=\"https:\/\/en.wikipedia.org\/wiki\/Colon_(anatomy)\" class=\"mw-redirect\" title=\"Colon (anatomy)\" rel=\"external_link\" target=\"_blank\">colon<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Colonoscopy\" title=\"Colonoscopy\" rel=\"external_link\" target=\"_blank\">colonoscopy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sigmoidoscopy\" title=\"Sigmoidoscopy\" rel=\"external_link\" target=\"_blank\">sigmoidoscopy<\/a>)<\/li>\n<li>Magnification endoscopy<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bile_duct\" title=\"Bile duct\" rel=\"external_link\" target=\"_blank\">bile duct<\/a>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopic_retrograde_cholangiopancreatography\" title=\"Endoscopic retrograde cholangiopancreatography\" rel=\"external_link\" target=\"_blank\">endoscopic retrograde cholangiopancreatography<\/a> (ERCP), duodenoscope-assisted cholangiopancreatoscopy, intraoperative cholangioscopy<\/li><\/ul><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Rectum\" title=\"Rectum\" rel=\"external_link\" target=\"_blank\">rectum<\/a> (rectoscopy) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anus\" title=\"Anus\" rel=\"external_link\" target=\"_blank\">anus<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Anoscopy\" title=\"Anoscopy\" rel=\"external_link\" target=\"_blank\">anoscopy<\/a>), both also referred to as (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Proctoscopy\" title=\"Proctoscopy\" rel=\"external_link\" target=\"_blank\">proctoscopy<\/a>)<\/li><\/ul><\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Respiratory_tract\" title=\"Respiratory tract\" rel=\"external_link\" target=\"_blank\">respiratory tract<\/a>\n<ul><li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_nose\" title=\"Human nose\" rel=\"external_link\" target=\"_blank\">nose<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Rhinoscopy\" class=\"mw-redirect\" title=\"Rhinoscopy\" rel=\"external_link\" target=\"_blank\">rhinoscopy<\/a>)<\/li>\n<li>The lower <a href=\"https:\/\/en.wikipedia.org\/wiki\/Respiratory_tract\" title=\"Respiratory tract\" rel=\"external_link\" target=\"_blank\">respiratory tract<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Bronchoscopy\" title=\"Bronchoscopy\" rel=\"external_link\" target=\"_blank\">bronchoscopy<\/a>)<\/li><\/ul><\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ear\" title=\"Ear\" rel=\"external_link\" target=\"_blank\">ear<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Otoscope\" title=\"Otoscope\" rel=\"external_link\" target=\"_blank\">otoscope<\/a>)<\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urinary_tract\" class=\"mw-redirect\" title=\"Urinary tract\" rel=\"external_link\" target=\"_blank\">urinary tract<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Cystoscopy\" title=\"Cystoscopy\" rel=\"external_link\" target=\"_blank\">cystoscopy<\/a>)<\/li>\n<li>The female <a href=\"https:\/\/en.wikipedia.org\/wiki\/Reproductive_system\" title=\"Reproductive system\" rel=\"external_link\" target=\"_blank\">reproductive system<\/a> (gynoscopy)\n<ul><li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervix\" title=\"Cervix\" rel=\"external_link\" target=\"_blank\">cervix<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Colposcopy\" title=\"Colposcopy\" rel=\"external_link\" target=\"_blank\">colposcopy<\/a>)<\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Uterus\" title=\"Uterus\" rel=\"external_link\" target=\"_blank\">uterus<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Hysteroscopy\" title=\"Hysteroscopy\" rel=\"external_link\" target=\"_blank\">hysteroscopy<\/a>)<\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fallopian_tube\" title=\"Fallopian tube\" rel=\"external_link\" target=\"_blank\">fallopian tubes<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Falloposcopy\" title=\"Falloposcopy\" rel=\"external_link\" target=\"_blank\">falloposcopy<\/a>)<\/li><\/ul><\/li>\n<li>Normally closed body cavities (through a small incision):\n<ul><li>The abdominal or pelvic cavity (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopy\" title=\"Laparoscopy\" rel=\"external_link\" target=\"_blank\">laparoscopy<\/a>)<\/li>\n<li>The interior of a joint (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Arthroscopy\" title=\"Arthroscopy\" rel=\"external_link\" target=\"_blank\">arthroscopy<\/a>)<\/li>\n<li>Organs of the chest (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Thoracoscopy\" title=\"Thoracoscopy\" rel=\"external_link\" target=\"_blank\">thoracoscopy<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mediastinoscopy\" title=\"Mediastinoscopy\" rel=\"external_link\" target=\"_blank\">mediastinoscopy<\/a>)<\/li><\/ul><\/li><\/ul>\n<p>Endoscopy is used for many procedures:\n<\/p>\n<ul><li>During <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pregnancy\" title=\"Pregnancy\" rel=\"external_link\" target=\"_blank\">pregnancy<\/a>\n<ul><li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Amnion\" title=\"Amnion\" rel=\"external_link\" target=\"_blank\">amnion<\/a> ()<\/li>\n<li>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fetus\" title=\"Fetus\" rel=\"external_link\" target=\"_blank\">fetus<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Fetoscopy\" title=\"Fetoscopy\" rel=\"external_link\" target=\"_blank\">fetoscopy<\/a>)<\/li><\/ul><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic_surgery\" title=\"Plastic surgery\" rel=\"external_link\" target=\"_blank\">Plastic surgery<\/a><\/li>\n<li>Panendoscopy (or triple endoscopy)\n<ul><li>Combines <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laryngoscopy\" title=\"Laryngoscopy\" rel=\"external_link\" target=\"_blank\">laryngoscopy<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Esophagogastroduodenoscopy\" title=\"Esophagogastroduodenoscopy\" rel=\"external_link\" target=\"_blank\">esophagoscopy<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bronchoscopy\" title=\"Bronchoscopy\" rel=\"external_link\" target=\"_blank\">bronchoscopy<\/a><\/li><\/ul><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthopedic_surgery\" title=\"Orthopedic surgery\" rel=\"external_link\" target=\"_blank\">Orthopedic surgery<\/a>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hand_surgery\" title=\"Hand surgery\" rel=\"external_link\" target=\"_blank\">Hand surgery<\/a>, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopic_carpal_tunnel_release\" title=\"Endoscopic carpal tunnel release\" rel=\"external_link\" target=\"_blank\">endoscopic carpal tunnel release<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Knee_surgery\" class=\"mw-redirect\" title=\"Knee surgery\" rel=\"external_link\" target=\"_blank\">Knee surgery<\/a>, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anterior_cruciate_ligament_reconstruction\" title=\"Anterior cruciate ligament reconstruction\" rel=\"external_link\" target=\"_blank\">anterior cruciate ligament reconstruction<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Epidural_space\" title=\"Epidural space\" rel=\"external_link\" target=\"_blank\">Epidural space<\/a> ()<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bursa_(anatomy)\" class=\"mw-redirect\" title=\"Bursa (anatomy)\" rel=\"external_link\" target=\"_blank\">Bursae<\/a> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Bursectomy\" title=\"Bursectomy\" rel=\"external_link\" target=\"_blank\">Bursectomy<\/a>)<\/li><\/ul><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Endodontic\" class=\"mw-redirect\" title=\"Endodontic\" rel=\"external_link\" target=\"_blank\">Endodontic<\/a> surgery\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Maxillary_sinus\" title=\"Maxillary sinus\" rel=\"external_link\" target=\"_blank\">Maxillary sinus<\/a> surgery<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Apicoectomy\" title=\"Apicoectomy\" rel=\"external_link\" target=\"_blank\">Apicoectomy<\/a><\/li><\/ul><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopic_endonasal_surgery\" title=\"Endoscopic endonasal surgery\" rel=\"external_link\" target=\"_blank\">Endoscopic endonasal surgery<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopic_spinal_surgery\" class=\"mw-redirect\" title=\"Endoscopic spinal surgery\" rel=\"external_link\" target=\"_blank\">Endoscopic spinal surgery<\/a><\/li><\/ul>\n<p>An Endoscopy is a simple procedure which allows a doctor to look inside human bodies using an instrument called an endoscope. A cutting tool can be attached to the end of the endoscope, and the apparatus can then be used to perform surgery. This type of surgery is called Key hole surgery, and usually leaves only a tiny scar externally.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Application_in_other_fields\">Application in other fields<\/span><\/h2>\n<ul><li>The planning and architectural community use <a href=\"https:\/\/en.wikipedia.org\/wiki\/Architectural_endoscopy\" title=\"Architectural endoscopy\" rel=\"external_link\" target=\"_blank\">architectural endoscopy<\/a> for pre-visualization of scale models of proposed buildings and cities<\/li>\n<li>Internal inspection of complex technical systems (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Borescope\" title=\"Borescope\" rel=\"external_link\" target=\"_blank\">borescope<\/a>)<\/li>\n<li>Endoscopes are also a tool helpful in the examination of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Improvised_explosive_devices\" class=\"mw-redirect\" title=\"Improvised explosive devices\" rel=\"external_link\" target=\"_blank\">improvised explosive devices<\/a> by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bomb_disposal\" title=\"Bomb disposal\" rel=\"external_link\" target=\"_blank\">bomb disposal<\/a> personnel.<\/li>\n<li>The FBI uses endoscopes for conducting surveillance via tight spaces.<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Risks\">Risks<\/span><\/h2>\n<p>The main risks are infection, over-sedation, perforation, or a tear of the stomach or esophagus lining and bleeding.<sup id=\"rdp-ebb-cite_ref-\u201cNHS\u201d_8-0\" class=\"reference\"><a href=\"#cite_note-\u201cNHS\u201d-8\" rel=\"external_link\">[8]<\/a><\/sup> Although perforation generally requires surgery, certain cases may be treated with antibiotics and intravenous fluids. Bleeding may occur at the site of a biopsy or polyp removal. Such typically minor bleeding may simply stop on its own or be controlled by cauterisation. Seldom does surgery become necessary. Perforation and bleeding are rare during gastroscopy. Other minor risks include drug reactions and complications related to other diseases the patient may have. Consequently, patients should inform their doctor of all allergic tendencies and medical problems. Occasionally, the site of the sedative injection may become inflamed and tender for a short time. This is usually not serious and warm compresses for a few days are usually helpful. While any of these complications may possibly occur, it is good to remember that each of them occurs quite infrequently. A doctor can further discuss risks with the patient with regard to the particular need for gastroscopy.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"After_the_endoscopy\">After the endoscopy<\/span><\/h2>\n<p>After the procedure, the patient will be observed and monitored by a qualified individual in the endoscopy room, or a recovery area, until a significant portion of the medication has worn off. Occasionally the patient is left with a mild sore throat, which may respond to saline gargles, or chamomile tea. It may last for weeks or not happen at all. The patient may have a feeling of distention from the insufflated air that was used during the procedure. Both problems are mild and fleeting. When fully recovered, the patient will be instructed when to resume their usual diet (probably within a few hours) and will be allowed to be taken home. Where sedation has been used, most facilities mandate that the patient be taken home by another person and that he or she not drive or handle machinery for the remainder of the day. Patients who have had an endoscopy without sedation are able to leave unassisted.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Endoscope\">Endoscope<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\">Endoscope<\/a><\/div>\n<p>An <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\">endoscope<\/a> can consist of:\n<\/p>\n<ul><li>a rigid or flexible tube.<\/li>\n<li>a light delivery system to illuminate the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organ_(anatomy)\" title=\"Organ (anatomy)\" rel=\"external_link\" target=\"_blank\">organ<\/a> or object under inspection. The light source is normally outside the body and the light is typically directed via an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_fiber\" title=\"Optical fiber\" rel=\"external_link\" target=\"_blank\">optical fiber<\/a> system.<\/li>\n<li>a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lens_(optics)\" title=\"Lens (optics)\" rel=\"external_link\" target=\"_blank\">lens<\/a> system transmitting the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Image\" title=\"Image\" rel=\"external_link\" target=\"_blank\">image<\/a> from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Objective_lens\" class=\"mw-redirect\" title=\"Objective lens\" rel=\"external_link\" target=\"_blank\">objective lens<\/a> to the viewer, typically a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Relay_lens\" title=\"Relay lens\" rel=\"external_link\" target=\"_blank\">relay lens<\/a> system in the case of rigid endoscopes or a bundle of fiberoptics in the case of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiberscope\" title=\"Fiberscope\" rel=\"external_link\" target=\"_blank\">fiberscope<\/a>.<\/li>\n<li>an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eyepiece\" title=\"Eyepiece\" rel=\"external_link\" target=\"_blank\">eyepiece<\/a>. Modern instruments may be videoscopes, with no eyepiece. A camera transmits image to a screen for image capture.<\/li>\n<li>an additional channel to allow entry of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_instrument\" class=\"mw-redirect\" title=\"Medical instrument\" rel=\"external_link\" target=\"_blank\">medical instruments<\/a> or manipulators.<\/li><\/ul>\n<p>Patients undergoing the procedure may be offered <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sedation\" title=\"Sedation\" rel=\"external_link\" target=\"_blank\">sedation<\/a>, which includes its own risks.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History_2\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bozzini_Lichtleiter.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c8\/Bozzini_Lichtleiter.jpg\/220px-Bozzini_Lichtleiter.jpg\" width=\"220\" height=\"143\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bozzini_Lichtleiter.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Drawings of Bozzini's \"Lichtleiter\", an early <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\">endoscope<\/a><\/div><\/div><\/div>\n<p>The first endoscope was developed in 1806 by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Philipp_Bozzini\" title=\"Philipp Bozzini\" rel=\"external_link\" target=\"_blank\">Philipp Bozzini<\/a> in Mainz with his introduction of a \"Lichtleiter\" (light conductor) \"for the examinations of the canals and cavities of the human body\".<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> However, the disapproved of such curiosity.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> The first to use an endoscope in a successful operation was <a href=\"https:\/\/en.wikipedia.org\/wiki\/Antonin_Jean_Desormeaux\" title=\"Antonin Jean Desormeaux\" rel=\"external_link\" target=\"_blank\">Antonin Jean Desormeaux<\/a> whose invention was the state of the art before the invention of electricity.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (December 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>The use of electric light was a major step in the improvement of endoscopy. The first such lights were external although sufficiently capable of illumination to allow cystoscopy, hysteroscopy and sigmoidoscopy as well as examination of the nasal (and later thoracic) cavities as was being performed routinely in human patients by Sir Francis Cruise (using his own commercially available endoscope) by 1865 in the Mater Misericordiae Hospital in Dublin, Ireland.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> Later, smaller bulbs became available making internal light possible, for instance in a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hysteroscopy\" title=\"Hysteroscopy\" rel=\"external_link\" target=\"_blank\">hysteroscope<\/a> by in 1908.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hans_Christian_Jacobaeus\" title=\"Hans Christian Jacobaeus\" rel=\"external_link\" target=\"_blank\">Hans Christian Jacobaeus<\/a> has been given credit for the first large published series of endoscopic explorations of the abdomen and the thorax with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopy\" title=\"Laparoscopy\" rel=\"external_link\" target=\"_blank\">laparoscopy<\/a> (1912) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thoracoscopy\" title=\"Thoracoscopy\" rel=\"external_link\" target=\"_blank\">thoracoscopy<\/a> (1910)<sup id=\"rdp-ebb-cite_ref-pmid9876654_13-0\" class=\"reference\"><a href=\"#cite_note-pmid9876654-13\" rel=\"external_link\">[13]<\/a><\/sup> although the first reported thoracoscopic examination in a human was also by Cruise.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup>\n<\/p><p>Laparoscopy was used in the diagnosis of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Liver\" title=\"Liver\" rel=\"external_link\" target=\"_blank\">liver<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gallbladder\" title=\"Gallbladder\" rel=\"external_link\" target=\"_blank\">gallbladder<\/a> disease by in the 1930s.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> Hope reported in 1937 on the use of laparoscopy to diagnose <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ectopic_pregnancy\" title=\"Ectopic pregnancy\" rel=\"external_link\" target=\"_blank\">ectopic pregnancy<\/a>.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> In 1944, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Raoul_Palmer\" title=\"Raoul Palmer\" rel=\"external_link\" target=\"_blank\">Raoul Palmer<\/a> placed his patients in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trendelenburg_position\" title=\"Trendelenburg position\" rel=\"external_link\" target=\"_blank\">Trendelenburg position<\/a> after gaseous distention of the abdomen and thus was able to reliably perform <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gynecology\" class=\"mw-redirect\" title=\"Gynecology\" rel=\"external_link\" target=\"_blank\">gynecologic<\/a> laparoscopy.<sup id=\"rdp-ebb-cite_ref-Litynski_1997_17-0\" class=\"reference\"><a href=\"#cite_note-Litynski_1997-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Wolf_and_Storz\">Wolf and Storz<\/span><\/h3>\n<p>Georg Wolf (1873\u20131938) a Berlin manufacturer of rigid endoscopes, established in 1906, produced the Sussmann flexible gastroscope in 1911 (Modlin, Farhadi-Journal of Clinical Gastroenterology, 2000).<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> Karl Storz began producing instruments for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Otolaryngology\" class=\"mw-redirect\" title=\"Otolaryngology\" rel=\"external_link\" target=\"_blank\">ENT<\/a> specialists in 1945 through his company, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Karl_Storz_GmbH\" class=\"mw-redirect\" title=\"Karl Storz GmbH\" rel=\"external_link\" target=\"_blank\">Karl Storz GmbH<\/a>.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Fiber_optics\">Fiber optics<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:132px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Storz_Endoscopy_Unit.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/14\/Storz_Endoscopy_Unit.png\/130px-Storz_Endoscopy_Unit.png\" width=\"130\" height=\"311\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Storz_Endoscopy_Unit.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A Storz endoscopy unit used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laryngoscopy\" title=\"Laryngoscopy\" rel=\"external_link\" target=\"_blank\">laryngoscopy<\/a> exams of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vocal_folds\" class=\"mw-redirect\" title=\"Vocal folds\" rel=\"external_link\" target=\"_blank\">vocal folds<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glottis\" title=\"Glottis\" rel=\"external_link\" target=\"_blank\">glottis<\/a><\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Basil_Hirschowitz\" title=\"Basil Hirschowitz\" rel=\"external_link\" target=\"_blank\">Basil Hirschowitz<\/a> and Larry Curtiss invented the first fiber optic endoscope in 1957.<sup id=\"rdp-ebb-cite_ref-pmid2044933_20-0\" class=\"reference\"><a href=\"#cite_note-pmid2044933-20\" rel=\"external_link\">[20]<\/a><\/sup> Earlier in the 1950s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harold_Hopkins_(physicist)\" title=\"Harold Hopkins (physicist)\" rel=\"external_link\" target=\"_blank\">Harold Hopkins<\/a> had designed a \"fibroscope\" consisting of a bundle of flexible glass fibres able to coherently transmit an image. This proved useful both medically and industrially, and subsequent research led to further improvements in image quality. Further innovations included using additional fibres to channel light to the objective end from a powerful external source, thereby achieving the high level of full spectrum illumination that was needed for detailed viewing, and colour photography.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>The previous practice of a small filament lamp on the tip of the endoscope had left the choice of either viewing in a dim red light or increasing the light output - which carried the risk of burning the inside of the patient. Alongside the advances to the optics, the ability to 'steer' the tip was developed, as well as innovations in remotely operated surgical instruments contained within the body of the endoscope itself. This was the beginning of \"key-hole surgery\" as we know it today.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Rod-lens_endoscopes\">Rod-lens endoscopes<\/span><\/h3>\n<p>There were physical limits to the image quality of a fibroscope. A bundle of say 50,000 fibers gives effectively only a 50,000-pixel image, and continued flexing from use breaks fibers and so progressively loses pixels. Eventually so many are lost that the whole bundle must be replaced (at considerable expense). <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harold_Hopkins_(physicist)\" title=\"Harold Hopkins (physicist)\" rel=\"external_link\" target=\"_blank\">Harold Hopkins<\/a> realised that any further optical improvement would require a different approach. Previous rigid endoscopes suffered from low light transmittance and poor image quality. The surgical requirement of passing surgical tools as well as the illumination system within the endoscope's tube - which itself is limited in dimensions by the human body - left very little room for the imaging optics. The tiny lenses of a conventional system required supporting rings that would obscure the bulk of the lens area; they were difficult to manufacture and assemble and optically nearly useless.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>The elegant solution that Hopkins invented was to fill the air-spaces between the 'little lenses' with rods of glass. These fitted exactly the endoscope's tube, making them self-aligning, and required no other support. This allowed the little lenses to be dispensed with altogether. The rod-lenses were much easier to handle and used the maximum possible diameter available.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>With the appropriate curvature and coatings to the rod ends and optimal choices of glass-types, all calculated and specified by Hopkins, the image quality was transformed - even with tubes of only 1mm in diameter. With a high quality 'telescope' of such small diameter the tools and illumination system could be comfortably housed within an outer tube. Once again it was who produced the first of these new endoscopes as part of a long and productive partnership between the two men.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup>\n<\/p><p>Whilst there are regions of the body that will always require flexible endoscopes (principally the gastrointestinal tract), the rigid rod-lens endoscopes have such exceptional performance that they are still the preferred instrument and have enabled modern key-hole surgery. (Harold Hopkins was recognized and honoured for his advancement of medical-optic by the medical community worldwide. It formed a major part of the citation when he was awarded the Rumford Medal by the Royal Society in 1984.)\n<\/p><p>By measuring absorption of light by the blood (by passing the light through one fibre and collecting the light through another fibre) a doctor can estimate the proportion of haemoglobin in the blood and diagnose ulceration in the stomach.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Endoscope_reprocessing\">Endoscope reprocessing<\/span><\/h3>\n<p>High level disinfection of flexible endoscopes is required by all national guideline issuing bodies.<sup id=\"rdp-ebb-cite_ref-pmid28159069_22-0\" class=\"reference\"><a href=\"#cite_note-pmid28159069-22\" rel=\"external_link\">[22]<\/a><\/sup> The high level disinfection of endoscopes occurs during a multi-step process called reprocessing. Reprocessing endoscopes involves over 100 individuals steps.<sup id=\"rdp-ebb-cite_ref-pmid20679783_23-0\" class=\"reference\"><a href=\"#cite_note-pmid20679783-23\" rel=\"external_link\">[23]<\/a><\/sup> These steps can be broken down into broad categories of pre-cleaning, leak testing, manual cleaning, cleaning verification, visual inspection, high level disinfection, rinsing, drying, and storage.<sup id=\"rdp-ebb-cite_ref-pmid27684640_24-0\" class=\"reference\"><a href=\"#cite_note-pmid27684640-24\" rel=\"external_link\">[24]<\/a><\/sup> Failure to perform all of these steps correctly can lead to residual contamination remaining on endoscopes.\n<\/p><p>In the UK, stringent guidelines exist regarding the decontamination and disinfection of flexible endoscopes, the most recent being CfPP 01\u201306, released in 2013<sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup>\n<\/p><p>Rigid endoscopes, such as an Arthroscope, can be sterilized in the same way as surgical instruments, whereas heat labile flexible endoscopes cannot.<sup id=\"rdp-ebb-cite_ref-pmid24451088_26-0\" class=\"reference\"><a href=\"#cite_note-pmid24451088-26\" rel=\"external_link\">[26]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Recent_developments\">Recent developments<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Endoscope,_USB,_2015-05-30.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2d\/Endoscope%2C_USB%2C_2015-05-30.jpg\/220px-Endoscope%2C_USB%2C_2015-05-30.jpg\" width=\"220\" height=\"189\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Endoscope,_USB,_2015-05-30.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Low-cost waterproof USB endoscope for non-medical use.<\/div><\/div><\/div>\n<p>With the application of robotic systems, telesurgery was introduced as the surgeon could be at a site far removed from the patient. The first transatlantic surgery has been called the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lindbergh_Operation\" class=\"mw-redirect\" title=\"Lindbergh Operation\" rel=\"external_link\" target=\"_blank\">Lindbergh Operation<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Wireless oesophageal pH measuring devices can now be placed endoscopically, to record ph trends in an area remotely.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (February 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Endoscopy_VR_simulators\">Endoscopy VR simulators<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Virtual_reality\" title=\"Virtual reality\" rel=\"external_link\" target=\"_blank\">Virtual reality<\/a> simulators are being developed for training doctors on various endoscopy skills.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Disposable_endoscopy\">Disposable endoscopy<\/span><\/h3>\n<p>Disposable endoscopy is an emerging category of endoscopic instruments. Recent developments<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> have allowed the manufacture of endoscopes inexpensive enough to be used on a single patient only. It is meeting a growing demand to lessen the risk of cross contamination and hospital acquired diseases. A European consortium of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/SME_(society)\" title=\"SME (society)\" rel=\"external_link\" target=\"_blank\">SME<\/a> are working on the DUET (disposable use of endoscopy tool) project to build a disposable endoscope.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Capsule_endoscopy\">Capsule endoscopy<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capsule_endoscopy\" title=\"Capsule endoscopy\" rel=\"external_link\" target=\"_blank\">Capsule endoscopy<\/a><\/div>\n<p>Capsule endoscopes are pill-sized imaging devices that are swallowed by a patient and then record images of the gastrointestinal tract as they pass through naturally. Images are typically retrieved via wireless data transfer to an external receiver.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Augmented_reality\">Augmented reality<\/span><\/h3>\n<p>The endoscopic image can be combined with other image sources to provide the surgeon with additional information. For instance, the position of an anatomical structure or tumor might be shown in the endoscopic video.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"New_imaging_modalities\">New imaging modalities<\/span><\/h3>\n<p>Emerging endoscope technologies measure additional properties of light to improve contrast, such as optical polarization,<sup id=\"rdp-ebb-cite_ref-pmid25836165_31-0\" class=\"reference\"><a href=\"#cite_note-pmid25836165-31\" rel=\"external_link\">[31]<\/a><\/sup> optical phase, <sup id=\"rdp-ebb-cite_ref-pmid27279676_32-0\" class=\"reference\"><a href=\"#cite_note-pmid27279676-32\" rel=\"external_link\">[32]<\/a><\/sup> and additional wavelengths of light (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperspectral\" class=\"mw-redirect\" title=\"Hyperspectral\" rel=\"external_link\" target=\"_blank\">hyperspectral<\/a> endoscopy).<sup id=\"rdp-ebb-cite_ref-pmid21639573_33-0\" class=\"reference\"><a href=\"#cite_note-pmid21639573-33\" rel=\"external_link\">[33]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Portal-puzzle.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Portal-puzzle.svg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/f\/fd\/Portal-puzzle.svg\/16px-Portal-puzzle.svg.png\" width=\"16\" height=\"14\" class=\"noviewer\" \/><\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Endoscopy\" title=\"Portal:Endoscopy\" rel=\"external_link\" target=\"_blank\">Endoscopy portal<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 32em; -webkit-column-width: 32em; column-width: 32em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation encyclopaedia\">\"Endoscopy\". <i>British Medical Association Complete Family Health Encyclopedia<\/i>. Dorling Kindersley Limited. 1990.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Endoscopy&rft.btitle=British+Medical+Association+Complete+Family+Health+Encyclopedia&rft.pub=Dorling+Kindersley+Limited&rft.date=1990&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cancerresearchuk.org\/about-cancer\/cancers-in-general\/tests\/endoscopy\" target=\"_blank\">\"Endoscopy\"<\/a>. Cancer Research UK<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">5 November<\/span> 2015<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Endoscopy&rft.pub=Cancer+Research+UK&rft_id=http%3A%2F%2Fwww.cancerresearchuk.org%2Fabout-cancer%2Fcancers-in-general%2Ftests%2Fendoscopy&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/sshm.ac.uk\/wp-content\/uploads\/2013\/10\/PROCEEDINGS-SESSION-1994-1995-and-1995-1996.pdf\" target=\"_blank\">\"The Scottish Society of the History of Medicine\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=The+Scottish+Society+of+the+History+of+Medicine&rft_id=http%3A%2F%2Fsshm.ac.uk%2Fwp-content%2Fuploads%2F2013%2F10%2FPROCEEDINGS-SESSION-1994-1995-and-1995-1996.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-mayoendo-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-mayoendo_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-mayoendo_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-mayoendo_4-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Staff (2012). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mayoclinic.com\/health\/endoscopy\/MY00138\/METHOD=print\" target=\"_blank\">\"Upper endoscopy\"<\/a>. <i>Mayo Clinic<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">24 September<\/span> 2012<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Mayo+Clinic&rft.atitle=Upper+endoscopy&rft.date=2012&rft.au=Staff&rft_id=http%3A%2F%2Fwww.mayoclinic.com%2Fhealth%2Fendoscopy%2FMY00138%2FMETHOD%3Dprint&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-AGAfive-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-AGAfive_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFAmerican_Gastroenterological_Association\" class=\"citation\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Gastroenterological_Association\" title=\"American Gastroenterological Association\" rel=\"external_link\" target=\"_blank\">American Gastroenterological Association<\/a>, <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20120809143636\/http:\/\/choosingwisely.org\/wp-content\/uploads\/2012\/04\/5things_12_factsheet_AGA.pdf\" target=\"_blank\">\"Five Things Physicians and Patients Should Question\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>, <i>Choosing Wisely: an initiative of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/ABIM_Foundation\" class=\"mw-redirect\" title=\"ABIM Foundation\" rel=\"external_link\" target=\"_blank\">ABIM Foundation<\/a><\/i>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/American_Gastroenterological_Association\" title=\"American Gastroenterological Association\" rel=\"external_link\" target=\"_blank\">American Gastroenterological Association<\/a>, archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/choosingwisely.org\/wp-content\/uploads\/2012\/04\/5things_12_factsheet_AGA.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on August 9, 2012<span class=\"reference-accessdate\">, retrieved <span class=\"nowrap\">August 17,<\/span> 2012<\/span><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Choosing+Wisely%3A+an+initiative+of+the+ABIM+Foundation&rft.atitle=Five+Things+Physicians+and+Patients+Should+Question&rft.au=American+Gastroenterological+Association&rft_id=http%3A%2F%2Fchoosingwisely.org%2Fwp-content%2Fuploads%2F2012%2F04%2F5things_12_factsheet_AGA.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid21376940-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid21376940_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ (March 2011). \"American Gastroenterological Association medical position statement on the management of Barrett's esophagus\". <i>Gastroenterology<\/i>. <b>140<\/b> (3): 1084\u201391. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1053%2Fj.gastro.2011.01.030\" target=\"_blank\">10.1053\/j.gastro.2011.01.030<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21376940\" target=\"_blank\">21376940<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gastroenterology&rft.atitle=American+Gastroenterological+Association+medical+position+statement+on+the+management+of+Barrett%27s+esophagus&rft.volume=140&rft.issue=3&rft.pages=1084-91&rft.date=2011-03&rft_id=info%3Adoi%2F10.1053%2Fj.gastro.2011.01.030&rft_id=info%3Apmid%2F21376940&rft.aulast=Spechler&rft.aufirst=SJ&rft.au=Sharma%2C+P&rft.au=Souza%2C+RF&rft.au=Inadomi%2C+JM&rft.au=Shaheen%2C+NJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid18341497-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid18341497_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Wang KK, Sampliner RE (March 2008). \"Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus\". <i>The American Journal of Gastroenterology<\/i>. <b>103<\/b> (3): 788\u201397. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1572-0241.2008.01835.x\" target=\"_blank\">10.1111\/j.1572-0241.2008.01835.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18341497\" target=\"_blank\">18341497<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+American+Journal+of+Gastroenterology&rft.atitle=Updated+guidelines+2008+for+the+diagnosis%2C+surveillance+and+therapy+of+Barrett%27s+esophagus&rft.volume=103&rft.issue=3&rft.pages=788-97&rft.date=2008-03&rft_id=info%3Adoi%2F10.1111%2Fj.1572-0241.2008.01835.x&rft_id=info%3Apmid%2F18341497&rft.aulast=Wang&rft.aufirst=KK&rft.au=Sampliner%2C+RE&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-\u201cNHS\u201d-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-\u201cNHS\u201d_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nhs.uk\/conditions\/Endoscopy\/Pages\/Introduction.aspx\" target=\"_blank\">\"Endoscopy\"<\/a>. <i>NHS Choices<\/i>. NHS Gov.UK<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">April 20,<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=NHS+Choices&rft.atitle=Endoscopy&rft_id=http%3A%2F%2Fwww.nhs.uk%2Fconditions%2FEndoscopy%2FPages%2FIntroduction.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bozzini, Philipp (1806). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=dn8tAAAAcAAJ&pg=PA107\" target=\"_blank\">\"Lichtleiter, eine Erfindung zur Anschauung innerer Teile und Krankheiten, nebst der Abbildung\"<\/a> [Light conductor, an invention for examining internal parts and diseases, together with illustrations]. <i>Journal der practischen Arzneykunde und Wundarzneykunst<\/i> (in German). <b>24<\/b>: 107\u201324.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+der+practischen+Arzneykunde+und+Wundarzneykunst&rft.atitle=Lichtleiter%2C+eine+Erfindung+zur+Anschauung+innerer+Teile+und+Krankheiten%2C+nebst+der+Abbildung&rft.volume=24&rft.pages=107-24&rft.date=1806&rft.aulast=Bozzini&rft.aufirst=Philipp&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Ddn8tAAAAcAAJ%26pg%3DPA107&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Yamada T (2009-01-22). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q=first%20endoscope%20developed%20in%201806&f=false\"><i>Atlas of Gastroenterology<\/i><\/a>. John Wiley & Sons. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-4443-0342-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Atlas+of+Gastroenterology&rft.pub=John+Wiley+%26+Sons&rft.date=2009-01-22&rft.isbn=978-1-4443-0342-1&rft.aulast=Yamada&rft.aufirst=Tadataka&rft_id=https%3A%2F%2Fbooks.google.com%2F%3Fid%3DU6BdMMytieQC%26pg%3DPA884%26lpg%3DPA884%26dq%3Dfirst%2Bendoscope%2Bdeveloped%2Bin%2B1806%23v%3Donepage%26q%3Dfirst%2520endoscope%2520developed%2520in%25201806%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Caniggia A, Nuti R, Lore F, Martini G, Turchetti V, Righi G (April 1990). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2325571\" target=\"_blank\">\"Long-term treatment with calcitriol in postmenopausal osteoporosis\"<\/a>. <i>Metabolism<\/i>. <b>39<\/b> (4 Suppl 1): 43\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmj.1.223.345\" target=\"_blank\">10.1136\/bmj.1.223.345<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/JSTOR\" title=\"JSTOR\" rel=\"external_link\" target=\"_blank\">JSTOR<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.jstor.org\/stable\/25204557\" target=\"_blank\">25204557<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2325571\" target=\"_blank\">2325571<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Metabolism&rft.atitle=Long-term+treatment+with+calcitriol+in+postmenopausal+osteoporosis&rft.volume=39&rft.issue=4+Suppl+1&rft.pages=43-9&rft.date=1990-04&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2325571&rft_id=%2F%2Fwww.jstor.org%2Fstable%2F25204557&rft_id=info%3Adoi%2F10.1136%2Fbmj.1.223.345&rft.aulast=Caniggia&rft.aufirst=A&rft.au=Nuti%2C+R&rft.au=Lore%2C+F&rft.au=Martini%2C+G&rft.au=Turchetti%2C+V&rft.au=Righi%2C+G&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2325571&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Shawki O, Deshmukh S, Pacheco LA (2017). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=0SYLDgAAQBAJ&pg=PA13\" target=\"_blank\"><i>Mastering the Techniques in Hysteroscopy<\/i><\/a>. Jaypee Brothers Medical Publishers. pp. 13\u2013. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-93-86150-49-3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Mastering+the+Techniques+in+Hysteroscopy&rft.pages=13-&rft.pub=Jaypee+Brothers+Medical+Publishers&rft.date=2017&rft.isbn=978-93-86150-49-3&rft.aulast=Shawki&rft.aufirst=Osama&rft.au=Deshmukh%2C+Sushma&rft.au=Pacheco%2C+Luis+Alonso&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D0SYLDgAAQBAJ%26pg%3DPA13&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid9876654-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid9876654_13-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Litynski GS (1997). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3015224\" target=\"_blank\">\"Laparoscopy--the early attempts: spotlighting Georg Kelling and Hans Christian Jacobaeus\"<\/a>. <i>Jsls<\/i>. <b>1<\/b> (1): 83\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3015224\" target=\"_blank\">3015224<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9876654\" target=\"_blank\">9876654<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Jsls&rft.atitle=Laparoscopy--the+early+attempts%3A+spotlighting+Georg+Kelling+and+Hans+Christian+Jacobaeus&rft.volume=1&rft.issue=1&rft.pages=83-5&rft.date=1997&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3015224&rft_id=info%3Apmid%2F9876654&rft.aulast=Litynski&rft.aufirst=GS&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3015224&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Gordon S (2014). \"Art. VIII.\u2014Clinical reports of rare cases, occurring in the Whitworth and Hardwicke Hospitals\". <i>Dublin Quarterly Journal of Medical Science<\/i>. <b>41<\/b> (1): 83\u201399. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1007%2FBF02946459\" target=\"_blank\">10.1007\/BF02946459<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Dublin+Quarterly+Journal+of+Medical+Science&rft.atitle=Art.+VIII.%E2%80%94Clinical+reports+of+rare+cases%2C+occurring+in+the+Whitworth+and+Hardwicke+Hospitals&rft.volume=41&rft.issue=1&rft.pages=83-99&rft.date=2014&rft_id=info%3Adoi%2F10.1007%2FBF02946459&rft.aulast=Gordon&rft.aufirst=Samuel&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Wildhirt E, Kalk H (1977). <i>Neue Deutsche Biographie (NDB). Band 11<\/i>. Berlin: Duncker & Humblot. p. 60. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-3-428-00192-7.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Neue+Deutsche+Biographie+%28NDB%29.+Band+11&rft.place=Berlin&rft.pages=60&rft.pub=Duncker+%26+Humblot&rft.date=1977&rft.isbn=978-3-428-00192-7&rft.aulast=Wildhirt&rft.aufirst=Egmont&rft.au=Kalk%2C+Heinrich-Otto&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Balen AH, Creighton SM, Davies MC, MacDougall J, Stanhope R (2004-04-01). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=pCUgAwAAQBAJ&pg=PA131\" target=\"_blank\"><i>Paediatric and Adolescent Gynaecology: A Multidisciplinary Approach<\/i><\/a>. Cambridge University Press. pp. 131\u2013. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-107-32018-5.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Paediatric+and+Adolescent+Gynaecology%3A+A+Multidisciplinary+Approach&rft.pages=131-&rft.pub=Cambridge+University+Press&rft.date=2004-04-01&rft.isbn=978-1-107-32018-5&rft.aulast=Balen&rft.aufirst=AH&rft.au=Creighton%2C+SM&rft.au=Davies%2C+MC&rft.au=MacDougall%2C+J&rft.au=Stanhope%2C+R&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DpCUgAwAAQBAJ%26pg%3DPA131&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Litynski_1997-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Litynski_1997_17-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Litynski GS (1997). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3016739\" target=\"_blank\">\"Raoul Palmer, World War II, and transabdominal coelioscopy. Laparoscopy extends into gynecology\"<\/a>. <i>Journal of the Society of Laparoendoscopic Surgeons<\/i>. <b>1<\/b> (3): 289\u201392. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3016739\" target=\"_blank\">3016739<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9876691\" target=\"_blank\">9876691<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+Society+of+Laparoendoscopic+Surgeons&rft.atitle=Raoul+Palmer%2C+World+War+II%2C+and+transabdominal+coelioscopy.+Laparoscopy+extends+into+gynecology&rft.volume=1&rft.issue=3&rft.pages=289-92&rft.date=1997&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3016739&rft_id=info%3Apmid%2F9876691&rft.aulast=Litynski&rft.aufirst=GS&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3016739&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.richardwolfusa.com\/company\/100-years-of-innovation.html\" target=\"_blank\">\"About Richard Wolf Germany\"<\/a>. Richard Wolf Medical Instruments.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=About+Richard+Wolf+Germany&rft.pub=Richard+Wolf+Medical+Instruments&rft_id=https%3A%2F%2Fwww.richardwolfusa.com%2Fcompany%2F100-years-of-innovation.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Nezhat C (2005). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/laparoscopy.blogs.com\/endoscopyhistory\/chapter_19\/index.html\" target=\"_blank\">\"Chapter 19. 1960's\"<\/a>. <i>Nezhat's History of Endoscopy<\/i>. Society of Laparoendoscopic Surgeons.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Nezhat%27s+History+of+Endoscopy&rft.atitle=Chapter+19.+1960%27s&rft.date=2005&rft.aulast=Nezhat&rft.aufirst=Camran&rft_id=http%3A%2F%2Flaparoscopy.blogs.com%2Fendoscopyhistory%2Fchapter_19%2Findex.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid2044933-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid2044933_20-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Edmonson JM (1991). \"History of the instruments for gastrointestinal endoscopy\". <i>Gastrointestinal Endoscopy<\/i>. <b>37<\/b> (2 Suppl): S27\u201356. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0016-5107%2891%2970910-3\" target=\"_blank\">10.1016\/S0016-5107(91)70910-3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2044933\" target=\"_blank\">2044933<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gastrointestinal+Endoscopy&rft.atitle=History+of+the+instruments+for+gastrointestinal+endoscopy&rft.volume=37&rft.issue=2+Suppl&rft.pages=S27-56&rft.date=1991&rft_id=info%3Adoi%2F10.1016%2FS0016-5107%2891%2970910-3&rft_id=info%3Apmid%2F2044933&rft.aulast=Edmonson&rft.aufirst=JM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-21\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.haroldhopkins.org\/history.html\" target=\"_blank\">\"History\"<\/a>. <i>Harold Hopkins Society<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Harold+Hopkins+Society&rft.atitle=History&rft_id=http%3A%2F%2Fwww.haroldhopkins.org%2Fhistory.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid28159069-22\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid28159069_22-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ofstead CL, Wetzler HP, Heymann OL, Johnson EA, Eiland JE, Shaw MJ (February 2017). \"Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes: Results of visual inspections, biochemical markers, and microbial cultures\". <i>American Journal of Infection Control<\/i>. <b>45<\/b> (2): e26\u2013e33. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ajic.2016.10.017\" target=\"_blank\">10.1016\/j.ajic.2016.10.017<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28159069\" target=\"_blank\">28159069<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Infection+Control&rft.atitle=Longitudinal+assessment+of+reprocessing+effectiveness+for+colonoscopes+and+gastroscopes%3A+Results+of+visual+inspections%2C+biochemical+markers%2C+and+microbial+cultures&rft.volume=45&rft.issue=2&rft.pages=e26-e33&rft.date=2017-02&rft_id=info%3Adoi%2F10.1016%2Fj.ajic.2016.10.017&rft_id=info%3Apmid%2F28159069&rft.aulast=Ofstead&rft.aufirst=CL&rft.au=Wetzler%2C+HP&rft.au=Heymann%2C+OL&rft.au=Johnson%2C+EA&rft.au=Eiland%2C+JE&rft.au=Shaw%2C+MJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid20679783-23\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid20679783_23-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ofstead CL, Wetzler HP, Snyder AK, Horton RA (2010). \"Endoscope reprocessing methods: a prospective study on the impact of human factors and automation\". <i>Gastroenterology Nursing<\/i>. <b>33<\/b> (4): 304\u201311. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FSGA.0b013e3181e9431a\" target=\"_blank\">10.1097\/SGA.0b013e3181e9431a<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20679783\" target=\"_blank\">20679783<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gastroenterology+Nursing&rft.atitle=Endoscope+reprocessing+methods%3A+a+prospective+study+on+the+impact+of+human+factors+and+automation&rft.volume=33&rft.issue=4&rft.pages=304-11&rft.date=2010&rft_id=info%3Adoi%2F10.1097%2FSGA.0b013e3181e9431a&rft_id=info%3Apmid%2F20679783&rft.aulast=Ofstead&rft.aufirst=CL&rft.au=Wetzler%2C+HP&rft.au=Snyder%2C+AK&rft.au=Horton%2C+RA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid27684640-24\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid27684640_24-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Herrin A, Loyola M, Bocian S, Diskey A, Friis CM, Herron-Rice L, Juan MR, Schmelzer M, Selking S (2016). \"Standards of Infection Prevention in Reprocessing Flexible Gastrointestinal Endoscopes\". <i>Gastroenterology Nursing<\/i>. <b>39<\/b> (5): 404\u201318. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FSGA.0000000000000266\" target=\"_blank\">10.1097\/SGA.0000000000000266<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27684640\" target=\"_blank\">27684640<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gastroenterology+Nursing&rft.atitle=Standards+of+Infection+Prevention+in+Reprocessing+Flexible+Gastrointestinal+Endoscopes&rft.volume=39&rft.issue=5&rft.pages=404-18&rft.date=2016&rft_id=info%3Adoi%2F10.1097%2FSGA.0000000000000266&rft_id=info%3Apmid%2F27684640&rft.aulast=Herrin&rft.aufirst=A&rft.au=Loyola%2C+M&rft.au=Bocian%2C+S&rft.au=Diskey%2C+A&rft.au=Friis%2C+CM&rft.au=Herron-Rice%2C+L&rft.au=Juan%2C+MR&rft.au=Schmelzer%2C+M&rft.au=Selking%2C+S&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-25\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/148559\/CFPP_01-06_Operational_mgmt_Final.pdf\" target=\"_blank\">\"Health Technical Memorandum 01-06: Decontamination of exible endoscopes Part C: Operational management\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. United Kingdom Department of Health. March 2016.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Health+Technical+Memorandum+01-06%3A+Decontamination+of++exible+endoscopes+Part+C%3A+Operational+management&rft.pub=United+Kingdom+Department+of+Health&rft.date=2016-03&rft_id=https%3A%2F%2Fwww.gov.uk%2Fgovernment%2Fuploads%2Fsystem%2Fuploads%2Fattachment_data%2Ffile%2F148559%2FCFPP_01-06_Operational_mgmt_Final.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid24451088-26\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid24451088_26-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sabnis RB, Bhattu A, Vijaykumar M (March 2014). \"Sterilization of endoscopic instruments\". <i>Current Opinion in Urology<\/i>. <b>24<\/b> (2): 195\u2013202. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2FMOU.0000000000000034\" target=\"_blank\">10.1097\/MOU.0000000000000034<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24451088\" target=\"_blank\">24451088<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Current+Opinion+in+Urology&rft.atitle=Sterilization+of+endoscopic+instruments&rft.volume=24&rft.issue=2&rft.pages=195-202&rft.date=2014-03&rft_id=info%3Adoi%2F10.1097%2FMOU.0000000000000034&rft_id=info%3Apmid%2F24451088&rft.aulast=Sabnis&rft.aufirst=RB&rft.au=Bhattu%2C+A&rft.au=Vijaykumar%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-27\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=ogMr5u5oqN8\" target=\"_blank\">\"Overview of Endoscopy Haptics Simulator Project\"<\/a>. <i>M2D2 Laboratory, Indian Institute of Science<\/i>. YouTube.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=M2D2+Laboratory%2C+Indian+Institute+of+Science&rft.atitle=Overview+of+Endoscopy+Haptics+Simulator+Project&rft_id=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DogMr5u5oqN8&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-28\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-28\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110720064520\/http:\/\/www.fraunhofer.de\/en\/press\/research-news\/2010-2011\/15\/cameras-out-of-the-salt-shaker.jsp\" target=\"_blank\">\"Dokument nicht gefunden\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fraunhofer.de\/en\/press\/research-news\/2010-2011\/15\/cameras-out-of-the-salt-shaker.jsp\" target=\"_blank\">the original<\/a> on 2011-07-20.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Dokument+nicht+gefunden&rft_id=http%3A%2F%2Fwww.fraunhofer.de%2Fen%2Fpress%2Fresearch-news%2F2010-2011%2F15%2Fcameras-out-of-the-salt-shaker.jsp&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-29\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-29\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110723225345\/http:\/\/www.ist-world.org\/ProjectDetails.aspx?ProjectId=6ad6814768374801b7401a5ae435dec6\" target=\"_blank\">\"Development of a Disposable Use Endoscopy Tool\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ist-world.org\/ProjectDetails.aspx?ProjectId=6ad6814768374801b7401a5ae435dec6\" target=\"_blank\">the original<\/a> on 2011-07-23.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Development+of+a+Disposable+Use+Endoscopy+Tool&rft_id=http%3A%2F%2Fwww.ist-world.org%2FProjectDetails.aspx%3FProjectId%3D6ad6814768374801b7401a5ae435dec6&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=i4emmCcBb4s\" target=\"_blank\"><span class=\"plainlinks\">Augmented Reality: Path guidance to craniopharyngioma<\/span><\/a> on <a href=\"https:\/\/en.wikipedia.org\/wiki\/YouTube\" title=\"YouTube\" rel=\"external_link\" target=\"_blank\">YouTube<\/a><\/span>\n<\/li>\n<li id=\"cite_note-pmid25836165-31\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid25836165_31-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Manhas S, Vizet J, Deby S, Vanel JC, Boito P, Verdier M, De Martino A, Pagnoux D (February 2015). \"Demonstration of full 4\u00d74 Mueller polarimetry through an optical fiber for endoscopic applications\". <i>Optics Express<\/i>. <b>23<\/b> (3): 3047\u201354. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2015OExpr..23.3047M\" target=\"_blank\">2015OExpr..23.3047M<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1364%2FOE.23.003047\" target=\"_blank\">10.1364\/OE.23.003047<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25836165\" target=\"_blank\">25836165<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Optics+Express&rft.atitle=Demonstration+of+full+4%C3%974+Mueller+polarimetry+through+an+optical+fiber+for+endoscopic+applications&rft.volume=23&rft.issue=3&rft.pages=3047-54&rft.date=2015-02&rft_id=info%3Apmid%2F25836165&rft_id=info%3Adoi%2F10.1364%2FOE.23.003047&rft_id=info%3Abibcode%2F2015OExpr..23.3047M&rft.aulast=Manhas&rft.aufirst=S&rft.au=Vizet%2C+J&rft.au=Deby%2C+S&rft.au=Vanel%2C+JC&rft.au=Boito%2C+P&rft.au=Verdier%2C+M&rft.au=De+Martino%2C+A&rft.au=Pagnoux%2C+D&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid27279676-32\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid27279676_32-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation arxiv\">Gordon, GSD; Joseph, J; Alcolea, MP; Sawyer, T; Macfaden, AJ; Williams, C; Fitzpatrick, CRM; Jones, PH; di Pietro, M; Fitzgerald, RC; Wilkinson, TD; Bohndiek, SE. \"Quantitative phase and polarisation endoscopy applied to detection of early oesophageal tumourigenesis\". <a href=\"https:\/\/en.wikipedia.org\/wiki\/ArXiv\" title=\"ArXiv\" rel=\"external_link\" target=\"_blank\">arXiv<\/a>:<span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/arxiv.org\/abs\/1811.03977\" target=\"_blank\">1811.03977<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=preprint&rft.jtitle=arXiv&rft.atitle=Quantitative+phase+and+polarisation+endoscopy+applied+to+detection+of+early+oesophageal+tumourigenesis&rft_id=info%3Aarxiv%2F1811.03977&rft.aulast=Gordon&rft.aufirst=GSD&rft.au=Joseph%2C+J&rft.au=Alcolea%2C+MP&rft.au=Sawyer%2C+T&rft.au=Macfaden%2C+AJ&rft.au=Williams%2C+C&rft.au=Fitzpatrick%2C+CRM&rft.au=Jones%2C+PH&rft.au=di+Pietro%2C+M&rft.au=Fitzgerald%2C+RC&rft.au=Wilkinson%2C+TD&rft.au=Bohndiek%2C+SE&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid21639573-33\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid21639573_33-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Kester RT, Bedard N, Gao L, Tkaczyk TS (May 2011). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3107836\" target=\"_blank\">\"Real-time snapshot hyperspectral imaging endoscope\"<\/a>. <i>Journal of Biomedical Optics<\/i>. <b>16<\/b> (5): 056005. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bibcode\" title=\"Bibcode\" rel=\"external_link\" target=\"_blank\">Bibcode<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"http:\/\/adsabs.harvard.edu\/abs\/2011JBO....16e6005K\" target=\"_blank\">2011JBO....16e6005K<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1117%2F1.3574756\" target=\"_blank\">10.1117\/1.3574756<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3107836\" target=\"_blank\">3107836<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21639573\" target=\"_blank\">21639573<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Biomedical+Optics&rft.atitle=Real-time+snapshot+hyperspectral+imaging+endoscope&rft.volume=16&rft.issue=5&rft.pages=056005&rft.date=2011-05&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3107836&rft_id=info%3Apmid%2F21639573&rft_id=info%3Adoi%2F10.1117%2F1.3574756&rft_id=info%3Abibcode%2F2011JBO....16e6005K&rft.aulast=Kester&rft.aufirst=RT&rft.au=Bedard%2C+N&rft.au=Gao%2C+L&rft.au=Tkaczyk%2C+TS&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3107836&rfr_id=info%3Asid%2Fen.wikipedia.org%3AEndoscopy\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.endoatlas.com\/atlas_1.html\" target=\"_blank\">The Atlas of Gastrointestinal Endoscopy<\/a> endoatlas.com<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.gastrointestinalatlas.com\/english\/english.html\" target=\"_blank\">El Salvador Atlas of Gastrointestinal Endoscopy<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gastrolab.net\/welcome.htm\" target=\"_blank\">Gastrolab: Site in English, Swedish and Finnish with gastrointestinal endoscopy photolibrary<\/a><\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.massdevice.com\/blogs\/massdevice\/preventing-cross-contamination-flexible-endoscopes\" target=\"_blank\">Preventing cross-contamination from flexible endoscopes<\/a> massdevice.com<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.advancedimagingpro.com\/print\/Advanced-Imaging-Magazine\/Advances-in-Endoscopy\/1$5670\" target=\"_blank\">Advances in Endoscopy<\/a> advancedimagingpro.com<\/li><\/ul>\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1328\nCached time: 20181215162351\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.656 seconds\nReal time usage: 0.816 seconds\nPreprocessor visited node count: 3218\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 100083\/2097152 bytes\nTemplate argument size: 4897\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 9\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 90916\/5000000 bytes\nNumber of Wikibase entities loaded: 6\/400\nLua time usage: 0.359\/10.000 seconds\nLua memory usage: 6.99 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 668.617 1 -total\n<\/p>\n<pre>46.10% 308.260 1 Template:Reflist\n16.80% 112.328 14 Template:Cite_journal\n10.54% 70.488 8 Template:Fix\n 9.71% 64.913 1 Template:Commons_category\n 9.20% 61.515 1 Template:Infobox_medical_intervention\n 8.52% 56.980 1 Template:Cite_encyclopedia\n 8.40% 56.197 1 Template:Infobox\n 8.08% 54.054 7 Template:Fact\n 6.38% 42.671 11 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:197002-1!canonical and timestamp 20181215162351 and revision id 872145510\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscopy\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214659\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.018 seconds\nReal time usage: 0.176 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 167.293 1 - wikipedia:Endoscopy\n100.00% 167.293 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8566-0!*!*!*!*!*!* and timestamp 20181217214659 and revision id 24994\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Endoscopy\">https:\/\/www.limswiki.org\/index.php\/Endoscopy<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","1511b5ea96046b1f5ee06ec866bbcc44_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/69\/PENTAX_Colonoscope001.jpg\/560px-PENTAX_Colonoscope001.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/29\/Santiagodechile2007.jpg\/440px-Santiagodechile2007.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/PENTAX_Colonoscope002.jpg\/440px-PENTAX_Colonoscope002.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/86\/Insertion_tip_of_endoscope.jpg\/440px-Insertion_tip_of_endoscope.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0e\/Anoscope%2C_proctoscope_and_rectoscope.svg\/500px-Anoscope%2C_proctoscope_and_rectoscope.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/b3\/US_Navy_081117-N-7526R-568_Cmdr._Thomas_Nelson_and_Lt._Robert_Roadfuss_discuss_proper_procedures_while_performing_a_laparoscopic_cholecystectomy_surgery.jpg\/500px-US_Navy_081117-N-7526R-568_Cmdr._Thomas_Nelson_and_Lt._Robert_Roadfuss_discuss_proper_procedures_while_performing_a_laparoscopic_cholecystectomy_surgery.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7e\/Esophageal_Bougie_Dilator.jpg\/440px-Esophageal_Bougie_Dilator.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/c\/c8\/Bozzini_Lichtleiter.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/14\/Storz_Endoscopy_Unit.png\/260px-Storz_Endoscopy_Unit.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2d\/Endoscope%2C_USB%2C_2015-05-30.jpg\/440px-Endoscope%2C_USB%2C_2015-05-30.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/f\/fd\/Portal-puzzle.svg\/32px-Portal-puzzle.svg.png"],"1511b5ea96046b1f5ee06ec866bbcc44_timestamp":1545083219,"1015376d34b6db14e7bd61c81d508dc0_type":"article","1015376d34b6db14e7bd61c81d508dc0_title":"Dialysis","1015376d34b6db14e7bd61c81d508dc0_url":"https:\/\/www.limswiki.org\/index.php\/Dialysis","1015376d34b6db14e7bd61c81d508dc0_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tDialysis\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article is about renal dialysis. For other uses, see Dialysis (disambiguation).\nRenal DialysisPatient receiving hemodialysisSpecialtynephrology ICD-9-CM39.95MeSHD006435 MedlinePlus00743 [edit on Wikidata]\nIn medicine, dialysis (from Greek \u03b4\u03b9\u03ac\u03bb\u03c5\u03c3\u03b9\u03c2, di\u00e0lysis, \"dissolution\"; from \u03b4\u03b9\u03ac, di\u00e0, \"through\", and \u03bb\u03cd\u03c3\u03b9\u03c2, l\u1ef3sis, \"loosening or splitting\") is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally. This is referred to as renal replacement therapy.\nDialysis is used in patients with rapidly developing loss of kidney function, called acute kidney injury (previously called acute renal failure), or slowly worsening kidney function, called Stage 5 chronic kidney disease, (previously called chronic kidney failure and end-stage renal disease and end-stage kidney disease).\nDialysis is used as a temporary measure in either acute kidney injury or in those awaiting kidney transplant and as a permanent measure in those for whom a transplant is not indicated or not possible.[1]\nIn the United Kingdom and the United States, dialysis is paid for by the government for those who are eligible. The first successful dialysis was performed in 1943.\nIn research laboratories, dialysis technique can also be used to separate molecules based on their size. Additionally, it can be used to balance buffer between a sample and the solution \"dialysis bath\" or \"dialysate\"[2] that the sample is in. For dialysis in a laboratory, a tubular semipermeable membrane made of cellulose acetate or nitrocellulose is used.[3] Pore size is varied according to the size separation required with larger pore sizes allowing larger molecules to pass through the membrane. Solvents, ions and buffer can diffuse easily across the semipermeable membrane, but larger molecules are unable to pass through the pores. This can be used to purify proteins of interest from a complex mixture by removing smaller proteins and molecules.\n\nContents \n\n1 Background \n2 Principle \n3 Types \n\n3.1 Hemodialysis \n3.2 Peritoneal dialysis \n3.3 Hemofiltration \n3.4 Hemodiafiltration \n3.5 Intestinal dialysis \n\n\n4 Indications \n\n4.1 Acute indications \n4.2 Chronic indications \n\n\n5 Dialyzable substances \n\n5.1 Characteristics \n5.2 Substances \n\n\n6 Pediatric dialysis \n7 Dialysis in different countries \n\n7.1 In the United Kingdom \n7.2 In the United States \n7.3 In China \n\n\n8 History \n9 See also \n\n9.1 Materials and methods \n9.2 Medical applications \n\n\n10 References \n11 Bibliography \n12 Further reading \n13 External links \n\n\nBackground \n A hemodialysis machine\nThe kidneys have an important role in maintaining health. When the person is healthy, the kidneys maintain the body's internal equilibrium of water and minerals (sodium, potassium, chloride, calcium, phosphorus, magnesium, sulfate). The acidic metabolism end-products that the body cannot get rid of via respiration are also excreted through the kidneys. The kidneys also function as a part of the endocrine system, producing erythropoietin, calcitriol and renin. Erythropoietin is involved in the production of red blood cells and calcitriol plays a role in bone formation.[4] Dialysis is an imperfect treatment to replace kidney function because it does not correct the compromised endocrine functions of the kidney. Dialysis treatments replace some of these functions through diffusion (waste removal) and ultrafiltration (fluid removal).[5] Dialysis uses highly purified (also known as \"ultrapure\") water.[6]\n\nPrinciple \nDialysis works on the principles of the diffusion of solutes and ultrafiltration of fluid across a semi-permeable membrane. Diffusion is a property of substances in water; substances in water tend to move from an area of high concentration to an area of low concentration.[7] Blood flows by one side of a semi-permeable membrane, and a dialysate, or special dialysis fluid, flows by the opposite side. A semipermeable membrane is a thin layer of material that contains holes of various sizes, or pores. Smaller solutes and fluid pass through the membrane, but the membrane blocks the passage of larger substances (for example, red blood cells, large proteins). This replicates the filtering process that takes place in the kidneys when the blood enters the kidneys and the larger substances are separated from the smaller ones in the glomerulus.[7]\n\n Osmosis diffusion ultrafiltration and dialysis\nThe two main types of dialysis, hemodialysis and peritoneal dialysis, remove wastes and excess water from the blood in different ways.[1] Hemodialysis removes wastes and water by circulating blood outside the body through an external filter, called a dialyzer, that contains a semipermeable membrane. The blood flows in one direction and the dialysate flows in the opposite. The counter-current flow of the blood and dialysate maximizes the concentration gradient of solutes between the blood and dialysate, which helps to remove more urea and creatinine from the blood. The concentrations of solutes (for example potassium, phosphorus and urea) are undesirably high in the blood, but low or absent in the dialysis solution, and constant replacement of the dialysate ensures that the concentration of undesired solutes is kept low on this side of the membrane. The dialysis solution has levels of minerals like potassium and calcium that are similar to their natural concentration in healthy blood. For another solute, bicarbonate, dialysis solution level is set at a slightly higher level than in normal blood, to encourage diffusion of bicarbonate into the blood, to act as a pH buffer to neutralize the metabolic acidosis that is often present in these patients. The levels of the components of dialysate are typically prescribed by a nephrologist according to the needs of the individual patient.\nIn peritoneal dialysis, wastes and water are removed from the blood inside the body using the peritoneum as a natural semipermeable membrane. Wastes and excess water move from the blood, across the peritoneal membrane and into a special dialysis solution, called dialysate, in the abdominal cavity.\n\nTypes \nThere are three primary and two secondary types of dialysis: hemodialysis (primary), peritoneal dialysis (primary), hemofiltration (primary), hemodiafiltration (secondary) and intestinal dialysis (secondary).\n\nHemodialysis \nMain article: Hemodialysis\nIn hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, exposing it to a partially permeable membrane. The dialyzer is composed of thousands of tiny hollow synthetic fibers. The fiber wall acts as the semipermeable membrane. Blood flows through the fibers, dialysis solution flows around the outside of the fibers, and water and wastes move between these two solutions.[8] The cleansed blood is then returned via the circuit back to the body. Ultrafiltration occurs by increasing the hydrostatic pressure across the dialyzer membrane This usually is done by applying a negative pressure to the dialysate compartment of the dialyzer. This pressure gradient causes water and dissolved solutes to move from blood to dialysate and allows the removal of several litres of excess fluid during a typical 4-hour treatment.\nIn the United States, hemodialysis treatments are typically given in a dialysis center three times per week (due in the United States to Medicare reimbursement rules); however, as of 2005 over 2,500 people in the United States are dialyzing at home more frequently for various treatment lengths.[9] Studies have demonstrated the clinical benefits of dialyzing 5 to 7 times a week, for 6 to 8 hours. This type of hemodialysis is usually called nocturnal daily hemodialysis, which a study has shown it provides a significant improvement in both small and large molecular weight clearance and decreases the need for phosphate binders.[10] These frequent long treatments are often done at home while sleeping, but home dialysis is a flexible modality and schedules can be changed day to day, week to week. In general, studies show that both increased treatment length and frequency are clinically beneficial.[11]\n\n<\/p>Hemo-dialysis was one of the most common procedures performed in U.S. hospitals in 2011, occurring in 909,000 stays (a rate of 29 stays per 10,000 population).[12]\n\nPeritoneal dialysis \n Schematic diagram of peritoneal dialysis\nMain article: Peritoneal dialysis\nIn peritoneal dialysis, a sterile solution containing glucose (called dialysate) is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a partially permeable membrane.\nThis exchange is repeated 4\u20135 times per day; automatic systems can run more frequent exchange cycles overnight. Peritoneal dialysis is less efficient than hemodialysis, but because it is carried out for a longer period of time the net effect in terms of removal of waste products and of salt and water are similar to hemodialysis. Peritoneal dialysis is carried out at home by the patient, often without help. This frees patients from the routine of having to go to a dialysis clinic on a fixed schedule multiple times per week. Peritoneal dialysis can be performed with little to no specialized equipment (other than bags of fresh dialysate).\n\nHemofiltration \nMain article: Hemofiltration\n Continuous veno-venous haemofiltration with pre- and post-dilution (CVVH)\nHemofiltration is a similar treatment to hemodialysis, but it makes use of a different principle. The blood is pumped through a dialyzer or \"hemofilter\" as in dialysis, but no dialysate is used. A pressure gradient is applied; as a result, water moves across the very permeable membrane rapidly, \"dragging\" along with it many dissolved substances, including ones with large molecular weights, which are not cleared as well by hemodialysis. Salts and water lost from the blood during this process are replaced with a \"substitution fluid\" that is infused into the extracorporeal circuit during the treatment.\n\nHemodiafiltration \nHemodiafiltration is a combination of hemodialysis and hemofiltration, thus used to purify the blood from toxins when the kidney is not working normally and also used to treat acute kidney injury (AKI).\n\nIntestinal dialysis \n Continuous veno-venous haemodiafiltration (CVVHDF)\nIn intestinal dialysis, the diet is supplemented with soluble fibres such as acacia fibre, which is digested by bacteria in the colon. This bacterial growth increases the amount of nitrogen that is eliminated in fecal waste.[13][14][15] An alternative approach utilizes the ingestion of 1 to 1.5 liters of non-absorbable solutions of polyethylene glycol or mannitol every fourth hour.[16]\n\nIndications \nThe decision to initiate dialysis or hemofiltration in patients with kidney failure depends on several factors. These can be divided into acute or chronic indications.\n\nAcute indications \nIndications for dialysis in the patient with acute kidney injury are summarized with the vowel mnemonic of \"AEIOU\":[17]\n\nAcidemia from metabolic acidosis in situations in which correction with sodium bicarbonate is impractical or may result in fluid overload.\nElectrolyte abnormality, such as severe hyperkalemia, especially when combined with AKI.\nIntoxication, that is, acute poisoning with a dialyzable substance. These substances can be represented by the mnemonic SLIME: salicylic acid, lithium, isopropanol, magnesium-containing laxatives and ethylene glycol.\nOverload of fluid not expected to respond to treatment with diuretics\nUremia complications, such as pericarditis, encephalopathy, or gastrointestinal bleeding.\nChronic indications \nChronic dialysis may be indicated when a patient has symptomatic kidney failure and low glomerular filtration rate (GFR < 15 mL\/min).[18] Between 1996 and 2008, there was a trend to initiate dialysis at progressively higher estimated GFR, eGFR.\nA review of the evidence shows no benefit or potential harm with early dialysis initiation, which has been defined by start of dialysis at an estimated GFR of greater than 10ml\/min\/1.732. Observational data from large registries of dialysis patients suggests that early start of dialysis may be harmful.[19]\nThe most recent published guidelines from Canada, for when to initiate dialysis, recommend an intent to defer dialysis until a patient has definite kidney failure symptoms, which may occur at an estimated GFR of 5-9ml\/min\/1.732.[20]\n\nDialyzable substances \nCharacteristics \nDialyzable substances\u2014substances removeable with dialysis\u2014have these properties:\n\nLow molecular mass\nHigh water solubility\nLow protein binding capacity\nProlonged elimination (long half-life)\nSmall volume of distribution\nSubstances \nEthylene glycol\nProcainamide\nMethanol\nIsopropyl alcohol\nBarbiturates\nLithium\nBromide\nSotalol\nChloral hydrate\nEthanol\nAcetone\nAtenolol\nTheophylline\nSalicylates\nPediatric dialysis \nOver the past 20 years, children have benefited from major improvements in both technology and clinical management of dialysis. Morbidity during dialysis sessions has decreased with seizures being exceptional and hypotensive episodes rare. Pain and discomfort have been reduced with the use of chronic internal jugular venous catheters and anesthetic creams for fistula puncture. Non-invasive technologies to assess patient target dry weight and access flow can significantly reduce patient morbidity and health care costs.\nBiocompatible synthetic membranes, specific small size material dialyzers and new low extra-corporeal volume tubing have been developed for young infants. Arterial and venous tubing length is made of minimum length and diameter, a <80ml to <110ml volume tubing is designed for pediatric patients and a >130 to <224ml tubing are for adult patients, regardless of blood pump segment size, which can be of 6.4mm for normal dialysis or 8.0mm for high flux dialysis in all patients. All dialysis machine manufacturers design their machine to do the pediatric dialysis. In pediatric patients, the pump speed should be kept at low side, according to patient blood output capacity, and the clotting with heparin dose should be carefully monitored. The high flux dialysis (see below) is not recommended for pediatric patients.\nIn children, hemodialysis must be individualized and viewed as an \"integrated therapy\" that considers their long-term exposure to chronic renal failure treatment. Dialysis is seen only as a temporary measure for children compared with renal transplantation because this enables the best chance of rehabilitation in terms of educational and psychosocial functioning.long-term chronic dialysis, however, the highest standards should be applied to these children to preserve their future \"cardiovascular life\"\u2014which might include more dialysis time and on-line hemodiafiltration online hdf with synthetic high flux membranes with the surface area of 0.2sq.m to 0.8sq.m and blood tubing lines with the low volume yet large blood pump segment of 6.4\/8.0mm, if we are able to improve on the rather restricted concept of small-solute urea dialysis clearance.\n\nDialysis in different countries \nIn the United Kingdom \nThe National Health Service provides dialysis in the United Kingdom. In England the service is commissioned by NHS England. About 23,000 patients use the service each year.[21] Patient transport services are generally provided without charge, for patients who need to travel to dialysis centres. Cornwall Clinical Commissioning Group proposed to restrict this provision to patients who did not have specific medical or financial reasons in 2018 but changed their minds after a campaign led by Kidney Care UK and decided to fund transport for patients requiring dialysis three times a week for a minimum of six weeks, or six times a month for a minimum of three months.[22]\n\nIn the United States \nSince 1972, the United States has covered the cost of dialysis and transplants for all citizens. By 2014, more than 460,000 Americans were undergoing treatment, the costs of which amount to 6 percent of the entire Medicare budget. Kidney disease is the ninth leading cause of death, and the U.S. has one of the highest mortality rates for dialysis care in the industrialized world. The rate of patients getting kidney transplants has been lower than expected. These outcomes have been blamed on a new for-profit dialysis industry responding to government payment policies.[23][24][25] A 1999 study concluded that \"patients treated in for-profit dialysis facilities have higher mortality rates and are less likely to be placed on the waiting list for a renal transplant than are patients who are treated in not-for-profit facilities\", possibly because transplantation removes a constant stream of revenue from the facility.[26] The insurance industry has complained about kickbacks and problematic relationships between charities and providers.[27]\n\nIn China \nThe Government of China provides the funding for dialysis treatment. There is a challenge to reach everyone who needs dialysis treatment because of the unequal distribution of health care resources and dialysis centers.[28] There are 395,121 individuals who receive hemodialysis or peritoneal dialysis in China per year. The percentage of the Chinese population with chronic kidney disease is 10.8%.[29] The Chinese Government is trying to increase the amount of peritoneal dialysis taking place to meet the needs of that nations's individuals with chronic kidney disease.[30]\n\nHistory \n Arm hooked up to dialysis tubing.\nA Dutch doctor, Willem Johan Kolff, constructed the first working dialyzer in 1943 during\nthe Nazi occupation of the Netherlands.[31] Due to the scarcity of available resources, Kolff had to improvise and build the initial machine using sausage casings, beverage cans, a washing machine and various other items that were available at the time. Over the following two years (1944\u20131945), Kolff used his machine to treat 16 patients suffering from acute kidney failure, but the results were unsuccessful. Then, in 1945, a 67-year-old comatose woman regained consciousness following 11 hours of hemodialysis with the dialyzer and lived for another seven years before dying from an unrelated condition. She was the first-ever patient successfully treated with dialysis.[31] Nils Alwall modified a similar construction to the Kolff dialysis machine by enclosing it inside a stainless steel canister. This allowed the removal of fluids, by applying a negative pressure to the outside canister, thus making it the first truly practical device for hemodialysis. Alwall treated his first patient in acute kidney failure on 3 September 1946.[citation needed ]\n\nSee also \nMaterials and methods \nThomas Graham (chemist), the founder of dialysis and father of colloid chemistry\nDialysis tubing\nList of US dialysis providers\nMedical applications \nApheresis, also known as plasmapheresis, is another extracorporeal technique that selectively removes specific constituents from blood\nHemodialysis\nPeritoneal dialysis\nAcute kidney failure\nKidney failure\nNephrology\nChronic kidney disease\nHepatorenal syndrome\nReferences \n\n\n^ a b Pendse S, Singh A, Zawada E. Initiation of Dialysis. In: Handbook of Dialysis. 4th ed. New York, NY; 2008:14\u201321 \n\n^ Garrett, Reginald H.; Grisham, Charles M. (2013). Biochemistry (5th ed.). p. 107. ISBN 978-1-133-10629-6. \n\n^ Ninfa, Alexander J.; Ballou, David P.; Benore, Marilee (2009). Fundamental Laboratory Approaches for Biochemistry and Biotechnology (2nd ed.). p. 45. ISBN 978-0-470-08766-4. \n\n^ Brundage D. Renal Disorders. St. Louis, MO: Mosby; 1992 \n\n^ \"Atlas of Diseases of the Kidney, Volume 5, Principles of Dialysis: Diffusion, Convection, and Dialysis Machines\" (PDF) . Retrieved 2011-09-02 . \n\n^ \"Home Hemodialysis and Water Treatment\". Davita. Retrieved 3 June 2017 . \n\n^ a b Mosby\u2019s Dictionary of Medicine, Nursing, & Health Professions. 7th ed. St. Louis, MO; Mosby: 2006 \n\n^ Ahmad S, Misra Hemodialysis Apparatus. In: Handbook of Dialysis. 4th ed. New York, NY; 2008:59-78. \n\n^ \"USRDS Treatment Modalities\" (PDF) . United States Renal Data System. Retrieved 2011-09-02 . \n\n^ Rocco, MV (July 2007). \"More Frequent Hemodialysis: Back to the Future?\". Advances in Chronic Kidney Disease. 14 (3): e1\u20139. doi:10.1053\/j.ackd.2007.04.006. PMID 17603969. \n\n^ Daily therapy study results compared Archived March 5, 2011, at the Wayback Machine. \n\n^ Pfuntner A., Wier L.M., Stocks C. Most Frequent Procedures Performed in U.S. Hospitals, 2011. HCUP Statistical Brief #165. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. [1]. \n\n^ \"Access\". Medscape. Retrieved 2011-09-02 . \n\n^ \"Access\". Medscape. Retrieved 2011-09-02 . \n\n^ \"Access\". Medscape. Retrieved 2011-09-02 . \n\n^ \"Access\". Medscape. Retrieved 2011-09-02 . \n\n^ Irwin, Richard S.; James M. Rippe (2008). Irwin and Rippe's intensive care medicine. Lippincott Williams & Wilkins. pp. 988\u2013999. ISBN 978-0-7817-9153-3. \n\n^ Tattersall, James; Dekker, Friedo; Heimb\u00fcrger, Olof; Jager, Kitty J.; Lameire, Norbert; Lindley, Elizabeth; Van Biesen, Wim; Vanholder, Raymond; Zoccali, Carmine (2011-07-01). \"When to start dialysis: updated guidance following publication of the Initiating Dialysis Early and Late (IDEAL) study\". Nephrology, Dialysis, Transplantation. 26 (7): 2082\u20132086. doi:10.1093\/ndt\/gfr168. ISSN 1460-2385. PMID 21551086. \n\n^ Rosansky, Steven; Glassock, Richard; Clark, William (2011). \"Early Start of Dialysis: A Critical Review\". Clin J Am Soc Nephrol. 6 (5): 1222\u20131228. doi:10.2215\/cjn.09301010. PMID 21555505. \n\n^ Nesrallah, Gihad (Feb 2014). \"Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic al indications for chronic dialysis\". CMAJ. 186 (2): 112\u2013117. doi:10.1503\/cmaj.130363. PMC 3903737 . PMID 24492525. \n\n^ \"Specialised service transfer reconsidered due to incorrect data\". Health Service Journal. 13 March 2015. Retrieved 20 April 2015 . \n\n^ \"CCG backs down over patient transport funding cuts\". Health Service Journal. 10 April 2018. Retrieved 29 May 2018 . \n\n^ Fields, Robin (2010-11-09). \"In Dialysis, Life-Saving Care at Great Risk and Cost\". ProPublica. Retrieved 2017-05-18 . \n\n^ \"John Oliver sees ills in for-profit dialysis centers\". Newsweek. 2017-05-15. Retrieved 2017-05-18 . \n\n^ \"Profit motive linked to dialysis deaths - UB Reporter\". www.buffalo.edu. Retrieved 2017-05-18 . \n\n^ Garg, Pushkal P.; Frick, Kevin D.; Diener-West, Marie; Powe, Neil R. (1999-11-25). \"Effect of the Ownership of Dialysis Facilities on Patients' Survival and Referral for Transplantation\". New England Journal of Medicine. 341 (22): 1653\u20131660. doi:10.1056\/NEJM199911253412205. ISSN 0028-4793. PMID 10572154. \n\n^ Abelson, Reed; Thomas, Katie (2016-07-01). \"UnitedHealthcare Sues Dialysis Chain Over Billing\". The New York Times. ISSN 0362-4331. Retrieved 2017-05-18 . \n\n^ JIN, Jian; WANG, Jianxiang; MA, Xiaoyi; WANG, Yuding; LI, Renyong (April 2015). \"Equality of Medical Health Resource Allocation in China Based on the Gini Coefficient Method\". Iranian Journal of Public Health. 44 (4): 445\u2013457. ISSN 2251-6085. PMC 4441957 . PMID 26056663. \n\n^ Zhang, Luxia; Wang, Fang; Wang, Li; Wang, Wenke; Liu, Bicheng; Liu, Jian; Chen, Menghua; He, Qiang; Liao, Yunhua (2012-03-03). \"Prevalence of chronic kidney disease in China: a cross-sectional survey\". The Lancet. 379 (9818): 815\u2013822. doi:10.1016\/S0140-6736(12)60033-6. PMID 22386035. \n\n^ Li, Philip Kam-Tao; Lui, Sing Leung; Ng, Jack Kit-Chung; Cai, Guan Yan; Chan, Christopher T; Chen, Hung Chun; Cheung, Alfred K; Choi, Koon Shing; Choong, Hui Lin (2017-12-01). \"Addressing the burden of dialysis around the world: A summary of the roundtable discussion on dialysis economics at the First International Congress of Chinese Nephrologists 2015\". Nephrology. 22: 3\u20138. doi:10.1111\/nep.13143. ISSN 1440-1797. PMID 29155495. \n\n^ a b Blakeslee, Sandra (12 February 2009). \"Willem Kolff, Doctor Who Invented Kidney and Heart Machines, Dies at 97\". The New York Times. New York Times. \n\n\nBibliography \n\nAl-Mosawi A. J. (2004). \"Acacia gum supplementation of a low-protein diet in children with end-stage renal disease\". Pediatric Nephrology. 19 (10): 1156\u20131159. doi:10.1007\/s00467-004-1562-5. PMID 15293039. \nAl Mosawi A. J. (2007). \"The use of acacia gum in end stage renal failure\". Journal of Tropical Pediatrics. 53 (5): 362\u2013365. doi:10.1093\/tropej\/fmm033. PMID 17517814. \nAli A. A.; Ali K. E.; Fadlalla A. E.; Khalid K. E. (2008). \"The effects of gum arabic oral treatment on the metabolic profile of chronic renal failure patients under regular haemodialysis in Central Sudan\". Natural Product Research. 22 (1): 12\u201321. doi:10.1080\/14786410500463544. PMID 17999333. \nMiskowiak J (1991). \"Continuous Intestinal Dialysis for Uraemia by Intermittent Oral Intake of Non-Absorbable Solutions: An Experimental Study\". Scandinavian Journal of Urology and Nephrology. 25 (1): 71\u201374. doi:10.3109\/00365599109024532. \n\nFurther reading \nStefania Crowther; Lois Reynolds; Tilli Tansey, eds. (2009), History of Dialysis in the UK: c. 1950-1980, Wellcome Witnesses to Contemporary Medicine, History of Modern Biomedicine Research Group, ISBN 978-0-85484-122-6 , Wikidata Q29581768\nExternal links \n\n Dialysisat Wikipedia's sister projects \n \n \n Definitions from Wiktionary \n Media from Wikimedia Commons \n News from Wikinews \n Quotations from Wikiquote \n Texts from Wikisource \n Textbooks from Wikibooks \n Resources from Wikiversity \n \n \n\nMachine Cleans Blood While You Wait\u20141950 article on early use of dialysis machine at Bellevue Hospital New York City\u2014i.e. example of how complex and large early dialysis machines were\nHome Dialysis Museum\u2014History and pictures of dialysis machines through time\nIntroduction to Dialysis Machines\u2014Tutorial describing the main subfunctions of dialysis systems.\nFirst Nations man conducts own dialysis treatments to avoid move to the city\u2014CBC News (November 30, 2016)\nvteUrologic surgical and other procedures (ICD-9-CM V3 55\u201359+89.2, ICD-10-PCS 0T)Kidney\nNephrostomy (Percutaneous nephrostomy)\nNephrotomy\nEndoscopy\nNephroscopy\nRenal biopsy\nNephrectomy\nKidney transplantation\nNephropexy\nUreter\nUreterostomy\nUrinary diversion\nUreterosigmoidostomy\nUreterolysis\nUreteroscopy\nUrinary bladder\nCystectomy\nSuprapubic cystostomy\nCystoscopy\nUrethra\nUrethropexy\nUrethrotomy\nUrethral sounding\nUrethroplasty\nUrethral bulking injections\nCystourethrography\nGeneralMedical imaging:\nPyelogram (Intravenous pyelogram, Retrograde pyelogram)\nKidneys, ureters, and bladder x-ray\nRadioisotope renography\nCystography\nRetrograde urethrogram\nVoiding cystourethrogram\nUrodynamic testing\nCystometry\nother:\nUrinary catheterization\nDialysis\nLithotripsy:\nLaser lithotripsy\nExtracorporeal shock wave lithotripsy\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:36.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 780 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","1015376d34b6db14e7bd61c81d508dc0_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Dialysis skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Dialysis<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">This article is about renal dialysis. For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dialysis_(disambiguation)\" class=\"mw-disambig\" title=\"Dialysis (disambiguation)\" rel=\"external_link\" target=\"_blank\">Dialysis (disambiguation)<\/a>.<\/div>\n\n<p>In medicine, <b>dialysis<\/b> (from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Greek_(language)\" class=\"mw-redirect\" title=\"Greek (language)\" rel=\"external_link\" target=\"_blank\">Greek<\/a> \u03b4\u03b9\u03ac\u03bb\u03c5\u03c3\u03b9\u03c2, <i>di\u00e0lysis<\/i>, \"dissolution\"; from \u03b4\u03b9\u03ac, <i>di\u00e0<\/i>, \"<i>through<\/i>\", and \u03bb\u03cd\u03c3\u03b9\u03c2, <i>l\u1ef3sis<\/i>, \"loosening or splitting\") is the process of removing excess <a href=\"https:\/\/en.wikipedia.org\/wiki\/Water\" title=\"Water\" rel=\"external_link\" target=\"_blank\">water<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Solutes\" class=\"mw-redirect\" title=\"Solutes\" rel=\"external_link\" target=\"_blank\">solutes<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toxins\" class=\"mw-redirect\" title=\"Toxins\" rel=\"external_link\" target=\"_blank\">toxins<\/a> from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood\" title=\"Blood\" rel=\"external_link\" target=\"_blank\">blood<\/a> in people whose kidneys can no longer perform these functions naturally. This is referred to as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Renal_replacement_therapy\" title=\"Renal replacement therapy\" rel=\"external_link\" target=\"_blank\">renal replacement therapy<\/a>.\n<\/p><p>Dialysis is used in patients with rapidly developing loss of kidney function, called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acute_kidney_injury\" title=\"Acute kidney injury\" rel=\"external_link\" target=\"_blank\">acute kidney injury<\/a> (previously called acute renal failure), or slowly worsening kidney function, called Stage 5 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_kidney_disease\" title=\"Chronic kidney disease\" rel=\"external_link\" target=\"_blank\">chronic kidney disease<\/a>, (previously called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_kidney_failure\" class=\"mw-redirect\" title=\"Chronic kidney failure\" rel=\"external_link\" target=\"_blank\">chronic kidney failure<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/End-stage_renal_disease\" class=\"mw-redirect\" title=\"End-stage renal disease\" rel=\"external_link\" target=\"_blank\">end-stage renal disease<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/End-stage_kidney_disease\" class=\"mw-redirect\" title=\"End-stage kidney disease\" rel=\"external_link\" target=\"_blank\">end-stage kidney disease<\/a>).\n<\/p><p>Dialysis is used as a temporary measure in either acute kidney injury or in those awaiting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_transplant\" class=\"mw-redirect\" title=\"Kidney transplant\" rel=\"external_link\" target=\"_blank\">kidney transplant<\/a> and as a permanent measure in those for whom a transplant is not indicated or not possible.<sup id=\"rdp-ebb-cite_ref-Pendse_1-0\" class=\"reference\"><a href=\"#cite_note-Pendse-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>In the United Kingdom and the United States, dialysis is paid for by the government for those who are eligible. The first successful dialysis was performed in 1943.\n<\/p><p>In research laboratories, dialysis technique can also be used to separate molecules based on their size. Additionally, it can be used to balance <a href=\"https:\/\/en.wikipedia.org\/wiki\/Buffer_solution\" title=\"Buffer solution\" rel=\"external_link\" target=\"_blank\">buffer<\/a> between a sample and the solution \"dialysis bath\" or \"dialysate\"<sup id=\"rdp-ebb-cite_ref-Garrett_2-0\" class=\"reference\"><a href=\"#cite_note-Garrett-2\" rel=\"external_link\">[2]<\/a><\/sup> that the sample is in. For dialysis in a laboratory, a tubular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semipermeable_membrane\" title=\"Semipermeable membrane\" rel=\"external_link\" target=\"_blank\">semipermeable membrane<\/a> made of cellulose acetate or nitrocellulose is used.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> Pore size is varied according to the size separation required with larger pore sizes allowing larger molecules to pass through the membrane. Solvents, ions and buffer can <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffuse\" class=\"mw-redirect\" title=\"Diffuse\" rel=\"external_link\" target=\"_blank\">diffuse<\/a> easily across the semipermeable membrane, but larger molecules are unable to pass through the pores. This can be used to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Protein_purification\" title=\"Protein purification\" rel=\"external_link\" target=\"_blank\">purify proteins<\/a> of interest from a complex mixture by removing smaller proteins and molecules.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Background\">Background<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hemodialysismachine.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fc\/Hemodialysismachine.jpg\/220px-Hemodialysismachine.jpg\" width=\"220\" height=\"313\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hemodialysismachine.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a> machine<\/div><\/div><\/div>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney\" title=\"Kidney\" rel=\"external_link\" target=\"_blank\">kidneys<\/a> have an important role in maintaining health. When the person is healthy, the kidneys maintain the body's internal equilibrium of water and minerals (sodium, potassium, chloride, calcium, phosphorus, magnesium, sulfate). The acidic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolism\" title=\"Metabolism\" rel=\"external_link\" target=\"_blank\">metabolism<\/a> end-products that the body cannot get rid of via respiration are also excreted through the kidneys. The kidneys also function as a part of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endocrine_system\" title=\"Endocrine system\" rel=\"external_link\" target=\"_blank\">endocrine system<\/a>, producing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Erythropoietin\" title=\"Erythropoietin\" rel=\"external_link\" target=\"_blank\">erythropoietin<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/1,25-dihydroxycholecalciferol\" class=\"mw-redirect\" title=\"1,25-dihydroxycholecalciferol\" rel=\"external_link\" target=\"_blank\">calcitriol<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Renin\" title=\"Renin\" rel=\"external_link\" target=\"_blank\">renin<\/a>. Erythropoietin is involved in the production of red blood cells and calcitriol plays a role in bone formation.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Dialysis is an imperfect treatment to replace kidney function because it does not correct the compromised endocrine functions of the kidney. Dialysis treatments replace some of these functions through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion\" title=\"Diffusion\" rel=\"external_link\" target=\"_blank\">diffusion<\/a> (waste removal) and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrafiltration\" title=\"Ultrafiltration\" rel=\"external_link\" target=\"_blank\">ultrafiltration<\/a> (fluid removal).<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Dialysis uses highly purified (also known as \"ultrapure\") water.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Principle\">Principle<\/span><\/h2>\n<p>Dialysis works on the principles of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diffusion\" title=\"Diffusion\" rel=\"external_link\" target=\"_blank\">diffusion<\/a> of solutes and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrafiltration\" title=\"Ultrafiltration\" rel=\"external_link\" target=\"_blank\">ultrafiltration<\/a> of fluid across a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semi-permeable_membrane\" class=\"mw-redirect\" title=\"Semi-permeable membrane\" rel=\"external_link\" target=\"_blank\">semi-permeable membrane<\/a>. Diffusion is a property of substances in water; substances in water tend to move from an area of high concentration to an area of low concentration.<sup id=\"rdp-ebb-cite_ref-Mosby_7-0\" class=\"reference\"><a href=\"#cite_note-Mosby-7\" rel=\"external_link\">[7]<\/a><\/sup> Blood flows by one side of a semi-permeable membrane, and a dialysate, or special dialysis fluid, flows by the opposite side. A semipermeable membrane is a thin layer of material that contains holes of various sizes, or pores. Smaller solutes and fluid pass through the membrane, but the membrane blocks the passage of larger substances (for example, red blood cells, large proteins). This replicates the filtering process that takes place in the kidneys when the blood enters the kidneys and the larger substances are separated from the smaller ones in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glomerulus\" title=\"Glomerulus\" rel=\"external_link\" target=\"_blank\">glomerulus<\/a>.<sup id=\"rdp-ebb-cite_ref-Mosby_7-1\" class=\"reference\"><a href=\"#cite_note-Mosby-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Osmosis_Diffusion_Ultrafiltration_and_Dialysis.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ae\/Osmosis_Diffusion_Ultrafiltration_and_Dialysis.svg\/220px-Osmosis_Diffusion_Ultrafiltration_and_Dialysis.svg.png\" width=\"220\" height=\"155\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Osmosis_Diffusion_Ultrafiltration_and_Dialysis.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Osmosis diffusion ultrafiltration and dialysis<\/div><\/div><\/div>\n<p>The two main types of dialysis, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_dialysis\" title=\"Peritoneal dialysis\" rel=\"external_link\" target=\"_blank\">peritoneal dialysis<\/a>, remove wastes and excess water from the blood in different ways.<sup id=\"rdp-ebb-cite_ref-Pendse_1-1\" class=\"reference\"><a href=\"#cite_note-Pendse-1\" rel=\"external_link\">[1]<\/a><\/sup> Hemodialysis removes wastes and water by circulating blood outside the body through an external filter, called a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dialyzer\" class=\"mw-redirect\" title=\"Dialyzer\" rel=\"external_link\" target=\"_blank\">dialyzer<\/a>, that contains a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semipermeable_membrane\" title=\"Semipermeable membrane\" rel=\"external_link\" target=\"_blank\">semipermeable membrane<\/a>. The blood flows in one direction and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dialysate\" class=\"mw-redirect\" title=\"Dialysate\" rel=\"external_link\" target=\"_blank\">dialysate<\/a> flows in the opposite. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Countercurrent_exchange\" title=\"Countercurrent exchange\" rel=\"external_link\" target=\"_blank\">counter-current flow<\/a> of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood\" title=\"Blood\" rel=\"external_link\" target=\"_blank\">blood<\/a> and dialysate maximizes the concentration gradient of solutes between the blood and dialysate, which helps to remove more urea and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Creatinine\" title=\"Creatinine\" rel=\"external_link\" target=\"_blank\">creatinine<\/a> from the blood. The concentrations of solutes (for example <a href=\"https:\/\/en.wikipedia.org\/wiki\/Potassium\" title=\"Potassium\" rel=\"external_link\" target=\"_blank\">potassium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphorus\" title=\"Phosphorus\" rel=\"external_link\" target=\"_blank\">phosphorus<\/a> and urea) are undesirably high in the blood, but low or absent in the dialysis solution, and constant replacement of the dialysate ensures that the concentration of undesired solutes is kept low on this side of the membrane. The dialysis solution has levels of minerals like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Potassium\" title=\"Potassium\" rel=\"external_link\" target=\"_blank\">potassium<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcium\" title=\"Calcium\" rel=\"external_link\" target=\"_blank\">calcium<\/a> that are similar to their natural concentration in healthy blood. For another solute, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bicarbonate\" title=\"Bicarbonate\" rel=\"external_link\" target=\"_blank\">bicarbonate<\/a>, dialysis solution level is set at a slightly higher level than in normal blood, to encourage diffusion of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bicarbonate\" title=\"Bicarbonate\" rel=\"external_link\" target=\"_blank\">bicarbonate<\/a> into the blood, to act as a pH buffer to neutralize the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolic_acidosis\" title=\"Metabolic acidosis\" rel=\"external_link\" target=\"_blank\">metabolic acidosis<\/a> that is often present in these patients. The levels of the components of dialysate are typically prescribed by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nephrologist\" class=\"mw-redirect\" title=\"Nephrologist\" rel=\"external_link\" target=\"_blank\">nephrologist<\/a> according to the needs of the individual patient.\n<\/p><p>In <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_dialysis\" title=\"Peritoneal dialysis\" rel=\"external_link\" target=\"_blank\">peritoneal dialysis<\/a>, wastes and water are removed from the blood inside the body using the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneum\" title=\"Peritoneum\" rel=\"external_link\" target=\"_blank\">peritoneum<\/a> as a natural semipermeable membrane. Wastes and excess water move from the blood, across the peritoneal membrane and into a special dialysis solution, called dialysate, in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdominal_cavity\" title=\"Abdominal cavity\" rel=\"external_link\" target=\"_blank\">abdominal cavity<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<p>There are three primary and two secondary types of dialysis: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a> (primary), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_dialysis\" title=\"Peritoneal dialysis\" rel=\"external_link\" target=\"_blank\">peritoneal dialysis<\/a> (primary), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemofiltration\" title=\"Hemofiltration\" rel=\"external_link\" target=\"_blank\">hemofiltration<\/a> (primary), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodiafiltration\" class=\"mw-redirect\" title=\"Hemodiafiltration\" rel=\"external_link\" target=\"_blank\">hemodiafiltration<\/a> (secondary) and (secondary).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hemodialysis\">Hemodialysis<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">Hemodialysis<\/a><\/div><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Hemodialysis-en.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Hemodialysis-en.svg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/93\/Hemodialysis-en.svg\/654px-Hemodialysis-en.svg.png\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a>\n<\/p><p>In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, exposing it to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Semipermeable_membrane\" title=\"Semipermeable membrane\" rel=\"external_link\" target=\"_blank\">partially permeable membrane<\/a>. The dialyzer is composed of thousands of tiny hollow <a href=\"https:\/\/en.wikipedia.org\/wiki\/Synthetic_fiber\" title=\"Synthetic fiber\" rel=\"external_link\" target=\"_blank\">synthetic fibers<\/a>. The fiber wall acts as the semipermeable membrane. Blood flows through the fibers, dialysis solution flows around the outside of the fibers, and water and wastes move between these two solutions.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> The cleansed blood is then returned via the circuit back to the body. Ultrafiltration occurs by increasing the hydrostatic pressure across the dialyzer membrane This usually is done by applying a negative pressure to the dialysate compartment of the dialyzer. This pressure gradient causes water and dissolved solutes to move from blood to dialysate and allows the removal of several litres of excess fluid during a typical 4-hour treatment.\n<p>In the United States, hemodialysis treatments are typically given in a dialysis center three times per week (due in the United States to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicare_(United_States)\" title=\"Medicare (United States)\" rel=\"external_link\" target=\"_blank\">Medicare<\/a> reimbursement rules); however, as of 2005 over 2,500 people in the United States are dialyzing at home more frequently for various treatment lengths.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> Studies have demonstrated the clinical benefits of dialyzing 5 to 7 times a week, for 6 to 8 hours. This type of hemodialysis is usually called <i>nocturnal daily hemodialysis<\/i>, which a study has shown it provides a significant improvement in both small and large <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_weight\" class=\"mw-redirect\" title=\"Molecular weight\" rel=\"external_link\" target=\"_blank\">molecular weight<\/a> clearance and decreases the need for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Phosphate_binder\" title=\"Phosphate binder\" rel=\"external_link\" target=\"_blank\">phosphate binders<\/a>.<sup id=\"rdp-ebb-cite_ref-pmid17603969_10-0\" class=\"reference\"><a href=\"#cite_note-pmid17603969-10\" rel=\"external_link\">[10]<\/a><\/sup> These frequent long treatments are often done at home while sleeping, but home dialysis is a flexible modality and schedules can be changed day to day, week to week. In general, studies show that both increased treatment length and frequency are clinically beneficial.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<\/p><p>Hemo-dialysis was one of the most common procedures performed in U.S. hospitals in 2011, occurring in 909,000 stays (a rate of 29 stays per 10,000 population).<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Peritoneal_dialysis\">Peritoneal dialysis<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Peritoneal_dialysis.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4e\/Peritoneal_dialysis.gif\/220px-Peritoneal_dialysis.gif\" width=\"220\" height=\"239\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Peritoneal_dialysis.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Schematic diagram of peritoneal dialysis<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_dialysis\" title=\"Peritoneal dialysis\" rel=\"external_link\" target=\"_blank\">Peritoneal dialysis<\/a><\/div>\n<p>In peritoneal dialysis, a sterile solution containing glucose (called dialysate) is run through a tube into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneum\" title=\"Peritoneum\" rel=\"external_link\" target=\"_blank\">peritoneal cavity<\/a>, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abdomen\" title=\"Abdomen\" rel=\"external_link\" target=\"_blank\">abdominal<\/a> body cavity around the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intestine\" class=\"mw-redirect\" title=\"Intestine\" rel=\"external_link\" target=\"_blank\">intestine<\/a>, where the peritoneal membrane acts as a partially permeable membrane.\n<\/p><p>This exchange is repeated 4\u20135 times per day; automatic systems can run more frequent exchange cycles overnight. Peritoneal dialysis is less efficient than hemodialysis, but because it is carried out for a longer period of time the net effect in terms of removal of waste products and of salt and water are similar to hemodialysis. Peritoneal dialysis is carried out at home by the patient, often without help. This frees patients from the routine of having to go to a dialysis clinic on a fixed schedule multiple times per week. Peritoneal dialysis can be performed with little to no specialized equipment (other than bags of fresh dialysate).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hemofiltration\">Hemofiltration<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemofiltration\" title=\"Hemofiltration\" rel=\"external_link\" target=\"_blank\">Hemofiltration<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Continuous_Venon_Venous_Haemofiltration_with_pre_and_post_dilution_(CVVH).svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d0\/Continuous_Venon_Venous_Haemofiltration_with_pre_and_post_dilution_%28CVVH%29.svg\/220px-Continuous_Venon_Venous_Haemofiltration_with_pre_and_post_dilution_%28CVVH%29.svg.png\" width=\"220\" height=\"155\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Continuous_Venon_Venous_Haemofiltration_with_pre_and_post_dilution_(CVVH).svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Continuous veno-venous haemofiltration with pre- and post-dilution (CVVH)<\/div><\/div><\/div>\n<p>Hemofiltration is a similar treatment to hemodialysis, but it makes use of a different principle. The blood is pumped through a dialyzer or \"hemofilter\" as in dialysis, but no dialysate is used. A pressure gradient is applied; as a result, water moves across the very permeable membrane rapidly, \"dragging\" along with it many dissolved substances, including ones with large molecular weights, which are not cleared as well by hemodialysis. Salts and water lost from the blood during this process are replaced with a \"substitution fluid\" that is infused into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Extracorporeal\" title=\"Extracorporeal\" rel=\"external_link\" target=\"_blank\">extracorporeal<\/a> circuit during the treatment.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Hemodiafiltration\">Hemodiafiltration<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodiafiltration\" class=\"mw-redirect\" title=\"Hemodiafiltration\" rel=\"external_link\" target=\"_blank\">Hemodiafiltration<\/a> is a combination of hemodialysis and hemofiltration, thus used to purify the blood from toxins when the kidney is not working normally and also used to treat <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acute_kidney_injury\" title=\"Acute kidney injury\" rel=\"external_link\" target=\"_blank\">acute kidney injury<\/a> (AKI).\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Intestinal_dialysis\">Intestinal dialysis<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Continuous_Venon_Venous_HaemoDIALAfiltration_(CVVHDF).svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e7\/Continuous_Venon_Venous_HaemoDIALAfiltration_%28CVVHDF%29.svg\/220px-Continuous_Venon_Venous_HaemoDIALAfiltration_%28CVVHDF%29.svg.png\" width=\"220\" height=\"155\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Continuous_Venon_Venous_HaemoDIALAfiltration_(CVVHDF).svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Continuous veno-venous haemodiafiltration (CVVHDF)<\/div><\/div><\/div>\n<p>In intestinal dialysis, the diet is supplemented with soluble fibres such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gum_arabic\" title=\"Gum arabic\" rel=\"external_link\" target=\"_blank\">acacia fibre<\/a>, which is digested by bacteria in the colon. This bacterial growth increases the amount of nitrogen that is eliminated in fecal waste.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup> An alternative approach utilizes the ingestion of 1 to 1.5 liters of non-absorbable solutions of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyethylene_glycol\" title=\"Polyethylene glycol\" rel=\"external_link\" target=\"_blank\">polyethylene glycol<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mannitol\" title=\"Mannitol\" rel=\"external_link\" target=\"_blank\">mannitol<\/a> every fourth hour.<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<p>The decision to initiate dialysis or hemofiltration in patients with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_failure\" title=\"Kidney failure\" rel=\"external_link\" target=\"_blank\">kidney failure<\/a> depends on several factors. These can be divided into acute or chronic indications.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Acute_indications\">Acute indications<\/span><\/h3>\n<p>Indications for dialysis in the patient with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acute_kidney_injury\" title=\"Acute kidney injury\" rel=\"external_link\" target=\"_blank\">acute kidney injury<\/a> are summarized with the vowel mnemonic of \"AEIOU\":<sup id=\"rdp-ebb-cite_ref-irwin_17-0\" class=\"reference\"><a href=\"#cite_note-irwin-17\" rel=\"external_link\">[17]<\/a><\/sup>\n<\/p>\n<ol><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Acidemia\" class=\"mw-redirect\" title=\"Acidemia\" rel=\"external_link\" target=\"_blank\">Acidemia<\/a> from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metabolic_acidosis\" title=\"Metabolic acidosis\" rel=\"external_link\" target=\"_blank\">metabolic acidosis<\/a> in situations in which correction with sodium bicarbonate is impractical or may result in fluid overload.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrolyte\" title=\"Electrolyte\" rel=\"external_link\" target=\"_blank\">Electrolyte<\/a> abnormality, such as severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hyperkalemia\" title=\"Hyperkalemia\" rel=\"external_link\" target=\"_blank\">hyperkalemia<\/a>, especially when combined with AKI.<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Substance_intoxication\" title=\"Substance intoxication\" rel=\"external_link\" target=\"_blank\">Intoxication<\/a>, that is, acute poisoning with a dialyzable substance. These substances can be represented by the mnemonic SLIME: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Salicylic_acid\" title=\"Salicylic acid\" rel=\"external_link\" target=\"_blank\">salicylic acid<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithium\" title=\"Lithium\" rel=\"external_link\" target=\"_blank\">lithium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isopropanol\" class=\"mw-redirect\" title=\"Isopropanol\" rel=\"external_link\" target=\"_blank\">isopropanol<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnesium\" title=\"Magnesium\" rel=\"external_link\" target=\"_blank\">magnesium<\/a>-containing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laxative\" title=\"Laxative\" rel=\"external_link\" target=\"_blank\">laxatives<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_glycol\" title=\"Ethylene glycol\" rel=\"external_link\" target=\"_blank\">ethylene glycol<\/a>.<\/li>\n<li>Overload of fluid not expected to respond to treatment with diuretics<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Uremia\" title=\"Uremia\" rel=\"external_link\" target=\"_blank\">Uremia<\/a> complications, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pericarditis\" title=\"Pericarditis\" rel=\"external_link\" target=\"_blank\">pericarditis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Encephalopathy\" title=\"Encephalopathy\" rel=\"external_link\" target=\"_blank\">encephalopathy<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Gastrointestinal_bleeding\" title=\"Gastrointestinal bleeding\" rel=\"external_link\" target=\"_blank\">gastrointestinal bleeding<\/a>.<\/li><\/ol>\n<h3><span class=\"mw-headline\" id=\"Chronic_indications\">Chronic indications<\/span><\/h3>\n<p>Chronic dialysis may be indicated when a patient has symptomatic kidney failure and low glomerular filtration rate (GFR < 15 mL\/min).<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> Between 1996 and 2008, there was a trend to initiate dialysis at progressively higher estimated GFR, eGFR.\nA review of the evidence shows no benefit or potential harm with early dialysis initiation, which has been defined by start of dialysis at an estimated GFR of greater than 10ml\/min\/1.73<sup>2<\/sup>. Observational data from large registries of dialysis patients suggests that early start of dialysis may be harmful.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\nThe most recent published guidelines from Canada, for when to initiate dialysis, recommend an intent to defer dialysis until a patient has definite kidney failure symptoms, which may occur at an estimated GFR of 5-9ml\/min\/1.73<sup>2<\/sup>.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Dialyzable_substances\">Dialyzable substances<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Characteristics\">Characteristics<\/span><\/h3>\n<p><a href=\"https:\/\/en.wiktionary.org\/wiki\/dialyzable\" class=\"extiw\" title=\"wiktionary:dialyzable\" rel=\"external_link\" target=\"_blank\">Dialyzable<\/a> substances\u2014substances removeable with dialysis\u2014have these properties:\n<\/p>\n<ol><li>Low <a href=\"https:\/\/en.wikipedia.org\/wiki\/Molecular_mass\" title=\"Molecular mass\" rel=\"external_link\" target=\"_blank\">molecular mass<\/a><\/li>\n<li>High water solubility<\/li>\n<li>Low protein binding capacity<\/li>\n<li>Prolonged elimination (long <a href=\"https:\/\/en.wikipedia.org\/wiki\/Half-life\" title=\"Half-life\" rel=\"external_link\" target=\"_blank\">half-life<\/a>)<\/li>\n<li>Small volume of distribution<\/li><\/ol>\n<h3><span class=\"mw-headline\" id=\"Substances\">Substances<\/span><\/h3>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethylene_glycol_poisoning\" title=\"Ethylene glycol poisoning\" rel=\"external_link\" target=\"_blank\">Ethylene glycol<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Procainamide\" title=\"Procainamide\" rel=\"external_link\" target=\"_blank\">Procainamide<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Methanol\" title=\"Methanol\" rel=\"external_link\" target=\"_blank\">Methanol<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Isopropyl_alcohol\" title=\"Isopropyl alcohol\" rel=\"external_link\" target=\"_blank\">Isopropyl alcohol<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Barbiturates\" class=\"mw-redirect\" title=\"Barbiturates\" rel=\"external_link\" target=\"_blank\">Barbiturates<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithium_(medication)\" title=\"Lithium (medication)\" rel=\"external_link\" target=\"_blank\">Lithium<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Potassium_bromide\" title=\"Potassium bromide\" rel=\"external_link\" target=\"_blank\">Bromide<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Sotalol\" title=\"Sotalol\" rel=\"external_link\" target=\"_blank\">Sotalol<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Chloral_hydrate\" title=\"Chloral hydrate\" rel=\"external_link\" target=\"_blank\">Chloral hydrate<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethanol\" title=\"Ethanol\" rel=\"external_link\" target=\"_blank\">Ethanol<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetone\" title=\"Acetone\" rel=\"external_link\" target=\"_blank\">Acetone<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Atenolol\" title=\"Atenolol\" rel=\"external_link\" target=\"_blank\">Atenolol<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Theophylline\" title=\"Theophylline\" rel=\"external_link\" target=\"_blank\">Theophylline<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Salicylic_acid\" title=\"Salicylic acid\" rel=\"external_link\" target=\"_blank\">Salicylates<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Pediatric_dialysis\">Pediatric dialysis<\/span><\/h2>\n<p>Over the past 20 years, children have benefited from major improvements in both technology and clinical management of dialysis. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Morbidity\" class=\"mw-redirect\" title=\"Morbidity\" rel=\"external_link\" target=\"_blank\">Morbidity<\/a> during dialysis sessions has decreased with seizures being exceptional and hypotensive episodes rare. Pain and discomfort have been reduced with the use of chronic internal jugular venous catheters and anesthetic creams for fistula puncture. Non-invasive technologies to assess patient target dry weight and access flow can significantly reduce patient morbidity and health care costs.\n<\/p><p>Biocompatible <a href=\"https:\/\/en.wikipedia.org\/wiki\/Synthetic_membranes\" class=\"mw-redirect\" title=\"Synthetic membranes\" rel=\"external_link\" target=\"_blank\">synthetic membranes<\/a>, specific small size material dialyzers and new low extra-corporeal volume tubing have been developed for young infants. Arterial and venous tubing length is made of minimum length and diameter, a <80ml to <110ml volume tubing is designed for pediatric patients and a >130 to <224ml tubing are for adult patients, regardless of blood pump segment size, which can be of 6.4mm for normal dialysis or 8.0mm for high flux dialysis in all patients. All dialysis machine manufacturers design their machine to do the pediatric dialysis. In pediatric patients, the pump speed should be kept at low side, according to patient blood output capacity, and the clotting with heparin dose should be carefully monitored. The high flux dialysis (see below) is not recommended for pediatric patients.\n<\/p><p>In children, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a> must be individualized and viewed as an \"integrated therapy\" that considers their long-term exposure to chronic renal failure treatment. Dialysis is seen only as a temporary measure for children compared with renal transplantation because this enables the best chance of rehabilitation in terms of educational and psychosocial functioning.long-term chronic dialysis, however, the highest standards should be applied to these children to preserve their future \"cardiovascular life\"\u2014which might include more dialysis time and on-line hemodiafiltration online hdf with synthetic high flux membranes with the surface area of 0.2sq.m to 0.8sq.m and blood tubing lines with the low volume yet large blood pump segment of 6.4\/8.0mm, if we are able to improve on the rather restricted concept of small-solute urea dialysis clearance.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Dialysis_in_different_countries\">Dialysis in different countries<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"In_the_United_Kingdom\">In the United Kingdom<\/span><\/h3>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/National_Health_Service\" title=\"National Health Service\" rel=\"external_link\" target=\"_blank\">National Health Service<\/a> provides dialysis in the United Kingdom. In England the service is commissioned by <a href=\"https:\/\/en.wikipedia.org\/wiki\/NHS_England\" title=\"NHS England\" rel=\"external_link\" target=\"_blank\">NHS England<\/a>. About 23,000 patients use the service each year.<sup id=\"rdp-ebb-cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\" rel=\"external_link\">[21]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_transport\" title=\"Patient transport\" rel=\"external_link\" target=\"_blank\">Patient transport<\/a> services are generally provided without charge, for patients who need to travel to dialysis centres. Cornwall <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clinical_Commissioning_Group\" class=\"mw-redirect\" title=\"Clinical Commissioning Group\" rel=\"external_link\" target=\"_blank\">Clinical Commissioning Group<\/a> proposed to restrict this provision to patients who did not have specific medical or financial reasons in 2018 but changed their minds after a campaign led by and decided to fund transport for patients requiring dialysis three times a week for a minimum of six weeks, or six times a month for a minimum of three months.<sup id=\"rdp-ebb-cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\" rel=\"external_link\">[22]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"In_the_United_States\">In the United States<\/span><\/h3>\n<p>Since 1972, the United States has covered the cost of dialysis and transplants for all citizens. By 2014, more than 460,000 Americans were undergoing treatment, the costs of which amount to 6 percent of the entire Medicare budget. Kidney disease is the ninth leading cause of death, and the U.S. has one of the highest mortality rates for dialysis care in the industrialized world. The rate of patients getting <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_transplantation\" title=\"Kidney transplantation\" rel=\"external_link\" target=\"_blank\">kidney transplants<\/a> has been lower than expected. These outcomes have been blamed on a new for-profit dialysis industry responding to government payment policies.<sup id=\"rdp-ebb-cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\" rel=\"external_link\">[23]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\" rel=\"external_link\">[24]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\" rel=\"external_link\">[25]<\/a><\/sup> A 1999 study concluded that \"patients treated in for-profit dialysis facilities have higher mortality rates and are less likely to be placed on the waiting list for a renal transplant than are patients who are treated in not-for-profit facilities\", possibly because transplantation removes a constant stream of revenue from the facility.<sup id=\"rdp-ebb-cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\" rel=\"external_link\">[26]<\/a><\/sup> The insurance industry has complained about kickbacks and problematic relationships between charities and providers.<sup id=\"rdp-ebb-cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\" rel=\"external_link\">[27]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"In_China\">In China<\/span><\/h3>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Government_of_China_(disambiguation)\" class=\"mw-disambig\" title=\"Government of China (disambiguation)\" rel=\"external_link\" target=\"_blank\">Government of China<\/a> provides the funding for dialysis treatment. There is a challenge to reach everyone who needs dialysis treatment because of the unequal distribution of health care resources and dialysis centers.<sup id=\"rdp-ebb-cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\" rel=\"external_link\">[28]<\/a><\/sup> There are 395,121 individuals who receive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_dialysis\" title=\"Peritoneal dialysis\" rel=\"external_link\" target=\"_blank\">peritoneal dialysis<\/a> in China per year. The percentage of the Chinese population with chronic kidney disease is 10.8%.<sup id=\"rdp-ebb-cite_ref-29\" class=\"reference\"><a href=\"#cite_note-29\" rel=\"external_link\">[29]<\/a><\/sup> The Chinese Government is trying to increase the amount of peritoneal dialysis taking place to meet the needs of that nations's individuals with chronic kidney disease.<sup id=\"rdp-ebb-cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\" rel=\"external_link\">[30]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:152px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dialysis_-_arm_-_01.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/54\/Dialysis_-_arm_-_01.jpg\/150px-Dialysis_-_arm_-_01.jpg\" width=\"150\" height=\"105\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dialysis_-_arm_-_01.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Arm hooked up to dialysis tubing.<\/div><\/div><\/div>\n<p>A Dutch doctor, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Willem_Johan_Kolff\" title=\"Willem Johan Kolff\" rel=\"external_link\" target=\"_blank\">Willem Johan Kolff<\/a>, constructed the first working dialyzer in 1943 during\nthe <a href=\"https:\/\/en.wikipedia.org\/wiki\/History_of_the_Netherlands_(1939%E2%80%931945)\" class=\"mw-redirect\" title=\"History of the Netherlands (1939\u20131945)\" rel=\"external_link\" target=\"_blank\">Nazi occupation of the Netherlands<\/a>.<sup id=\"rdp-ebb-cite_ref-NYT_31-0\" class=\"reference\"><a href=\"#cite_note-NYT-31\" rel=\"external_link\">[31]<\/a><\/sup> Due to the scarcity of available resources, Kolff had to improvise and build the initial machine using <a href=\"https:\/\/en.wikipedia.org\/wiki\/Casing_(sausage)\" class=\"mw-redirect\" title=\"Casing (sausage)\" rel=\"external_link\" target=\"_blank\">sausage casings<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Beverage_can\" class=\"mw-redirect\" title=\"Beverage can\" rel=\"external_link\" target=\"_blank\">beverage cans<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Washing_machine\" title=\"Washing machine\" rel=\"external_link\" target=\"_blank\">washing machine<\/a> and various other items that were available at the time. Over the following two years (1944\u20131945), Kolff used his machine to treat 16 patients suffering from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acute_kidney_failure\" class=\"mw-redirect\" title=\"Acute kidney failure\" rel=\"external_link\" target=\"_blank\">acute kidney failure<\/a>, but the results were unsuccessful. Then, in 1945, a 67-year-old comatose woman regained consciousness following 11 hours of hemodialysis with the dialyzer and lived for another seven years before dying from an unrelated condition. She was the first-ever patient successfully treated with dialysis.<sup id=\"rdp-ebb-cite_ref-NYT_31-1\" class=\"reference\"><a href=\"#cite_note-NYT-31\" rel=\"external_link\">[31]<\/a><\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nils_Alwall\" title=\"Nils Alwall\" rel=\"external_link\" target=\"_blank\">Nils Alwall<\/a> modified a similar construction to the Kolff dialysis machine by enclosing it inside a stainless steel canister. This allowed the removal of fluids, by applying a negative pressure to the outside canister, thus making it the first truly practical device for hemodialysis. Alwall treated his first patient in acute kidney failure on 3 September 1946.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (January 2018)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Materials_and_methods\">Materials and methods<\/span><\/h3>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Thomas_Graham_(chemist)\" title=\"Thomas Graham (chemist)\" rel=\"external_link\" target=\"_blank\">Thomas Graham (chemist)<\/a>, the founder of dialysis and father of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colloid_chemistry\" class=\"mw-redirect\" title=\"Colloid chemistry\" rel=\"external_link\" target=\"_blank\">colloid chemistry<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dialysis_tubing\" title=\"Dialysis tubing\" rel=\"external_link\" target=\"_blank\">Dialysis tubing<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/List_of_US_dialysis_providers\" title=\"List of US dialysis providers\" rel=\"external_link\" target=\"_blank\">List of US dialysis providers<\/a><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Medical_applications\">Medical applications<\/span><\/h3>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Apheresis\" title=\"Apheresis\" rel=\"external_link\" target=\"_blank\">Apheresis<\/a>, also known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plasmapheresis\" title=\"Plasmapheresis\" rel=\"external_link\" target=\"_blank\">plasmapheresis<\/a>, is another <a href=\"https:\/\/en.wikipedia.org\/wiki\/Extracorporeal\" title=\"Extracorporeal\" rel=\"external_link\" target=\"_blank\">extracorporeal<\/a> technique that selectively removes specific constituents from blood<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">Hemodialysis<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Peritoneal_dialysis\" title=\"Peritoneal dialysis\" rel=\"external_link\" target=\"_blank\">Peritoneal dialysis<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Acute_kidney_failure\" class=\"mw-redirect\" title=\"Acute kidney failure\" rel=\"external_link\" target=\"_blank\">Acute kidney failure<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Kidney_failure\" title=\"Kidney failure\" rel=\"external_link\" target=\"_blank\">Kidney failure<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Nephrology\" title=\"Nephrology\" rel=\"external_link\" target=\"_blank\">Nephrology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_kidney_disease\" title=\"Chronic kidney disease\" rel=\"external_link\" target=\"_blank\">Chronic kidney disease<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hepatorenal_syndrome\" title=\"Hepatorenal syndrome\" rel=\"external_link\" target=\"_blank\">Hepatorenal syndrome<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 33em; -webkit-column-width: 33em; column-width: 33em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-Pendse-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Pendse_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Pendse_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Pendse S, Singh A, Zawada E. Initiation of Dialysis. In: <i>Handbook of Dialysis<\/i>. 4th ed. New York, NY; 2008:14\u201321<\/span>\n<\/li>\n<li id=\"cite_note-Garrett-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Garrett_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Garrett, Reginald H.; Grisham, Charles M. (2013). <i>Biochemistry<\/i> (5th ed.). p. 107. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-1-133-10629-6.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Biochemistry&rft.pages=107&rft.edition=5th&rft.date=2013&rft.isbn=978-1-133-10629-6&rft.aulast=Garrett&rft.aufirst=Reginald+H.&rft.au=Grisham%2C+Charles+M.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Ninfa, Alexander J.; Ballou, David P.; Benore, Marilee (2009). <i>Fundamental Laboratory Approaches for Biochemistry and Biotechnology<\/i> (2nd ed.). p. 45. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-470-08766-4.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Fundamental+Laboratory+Approaches+for+Biochemistry+and+Biotechnology&rft.pages=45&rft.edition=2nd&rft.date=2009&rft.isbn=978-0-470-08766-4&rft.aulast=Ninfa&rft.aufirst=Alexander+J.&rft.au=Ballou%2C+David+P.&rft.au=Benore%2C+Marilee&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Brundage D. <i>Renal Disorders<\/i>. St. Louis, MO: Mosby; 1992<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.kidneyatlas.org\/book5\/adk5-01.ccc.QXD.pdf\" target=\"_blank\">\"Atlas of Diseases of the Kidney, Volume 5, Principles of Dialysis: Diffusion, Convection, and Dialysis Machines\"<\/a> <span class=\"cs1-format\">(PDF)<\/span><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-09-02<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Atlas+of+Diseases+of+the+Kidney%2C+Volume+5%2C+Principles+of+Dialysis%3A+Diffusion%2C+Convection%2C+and+Dialysis+Machines&rft_id=http%3A%2F%2Fwww.kidneyatlas.org%2Fbook5%2Fadk5-01.ccc.QXD.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.davita.com\/treatment-options\/hemodialysis\/home-hemodialysis\/home-hemodialysis-and-water-treatment\/t\/5581\" target=\"_blank\">\"Home Hemodialysis and Water Treatment\"<\/a>. <i>Davita<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">3 June<\/span> 2017<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Davita&rft.atitle=Home+Hemodialysis+and+Water+Treatment&rft_id=https%3A%2F%2Fwww.davita.com%2Ftreatment-options%2Fhemodialysis%2Fhome-hemodialysis%2Fhome-hemodialysis-and-water-treatment%2Ft%2F5581&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Mosby-7\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Mosby_7-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Mosby_7-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><i>Mosby\u2019s Dictionary of Medicine, Nursing, & Health Professions<\/i>. 7th ed. St. Louis, MO; Mosby: 2006<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Ahmad S, Misra Hemodialysis Apparatus. In: <i>Handbook of Dialysis<\/i>. 4th ed. New York, NY; 2008:59-78.<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.usrds.org\/2007\/pdf\/04_modalities_07.pdf\" target=\"_blank\">\"USRDS Treatment Modalities\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>United States Renal Data System<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2011-09-02<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=United+States+Renal+Data+System&rft.atitle=USRDS+Treatment+Modalities&rft_id=http%3A%2F%2Fwww.usrds.org%2F2007%2Fpdf%2F04_modalities_07.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-pmid17603969-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-pmid17603969_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Rocco, MV (July 2007). \"More Frequent Hemodialysis: Back to the Future?\". <i>Advances in Chronic Kidney Disease<\/i>. <b>14<\/b> (3): e1\u20139. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1053%2Fj.ackd.2007.04.006\" target=\"_blank\">10.1053\/j.ackd.2007.04.006<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17603969\" target=\"_blank\">17603969<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advances+in+Chronic+Kidney+Disease&rft.atitle=More+Frequent+Hemodialysis%3A+Back+to+the+Future%3F&rft.volume=14&rft.issue=3&rft.pages=e1-9&rft.date=2007-07&rft_id=info%3Adoi%2F10.1053%2Fj.ackd.2007.04.006&rft_id=info%3Apmid%2F17603969&rft.aulast=Rocco&rft.aufirst=MV&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.homedialysis.org\/learn\/types\/\" target=\"_blank\">Daily therapy study results compared<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20110305085319\/http:\/\/www.homedialysis.org\/learn\/types\/\" target=\"_blank\">Archived<\/a> March 5, 2011, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wayback_Machine\" title=\"Wayback Machine\" rel=\"external_link\" target=\"_blank\">Wayback Machine<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Pfuntner A., Wier L.M., Stocks C. Most Frequent Procedures Performed in U.S. Hospitals, 2011. HCUP Statistical Brief #165. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. <a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.hcup-us.ahrq.gov\/reports\/statbriefs\/sb165.jsp\" target=\"_blank\">[1]<\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.medscape.com\/medline\/abstract\/15293039\" target=\"_blank\">\"Access\"<\/a>. Medscape<span class=\"reference-accessdate\">. 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Wang, Fang; Wang, Li; Wang, Wenke; Liu, Bicheng; Liu, Jian; Chen, Menghua; He, Qiang; Liao, Yunhua (2012-03-03). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0140673612600336\" target=\"_blank\">\"Prevalence of chronic kidney disease in China: a cross-sectional survey\"<\/a>. <i>The Lancet<\/i>. <b>379<\/b> (9818): 815\u2013822. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2FS0140-6736%2812%2960033-6\" target=\"_blank\">10.1016\/S0140-6736(12)60033-6<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22386035\" target=\"_blank\">22386035<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Lancet&rft.atitle=Prevalence+of+chronic+kidney+disease+in+China%3A+a+cross-sectional+survey&rft.volume=379&rft.issue=9818&rft.pages=815-822&rft.date=2012-03-03&rft_id=info%3Adoi%2F10.1016%2FS0140-6736%2812%2960033-6&rft_id=info%3Apmid%2F22386035&rft.aulast=Zhang&rft.aufirst=Luxia&rft.au=Wang%2C+Fang&rft.au=Wang%2C+Li&rft.au=Wang%2C+Wenke&rft.au=Liu%2C+Bicheng&rft.au=Liu%2C+Jian&rft.au=Chen%2C+Menghua&rft.au=He%2C+Qiang&rft.au=Liao%2C+Yunhua&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS0140673612600336&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-30\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-30\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Li, Philip Kam-Tao; Lui, Sing Leung; Ng, Jack Kit-Chung; Cai, Guan Yan; Chan, Christopher T; Chen, Hung Chun; Cheung, Alfred K; Choi, Koon Shing; Choong, Hui Lin (2017-12-01). \"Addressing the burden of dialysis around the world: A summary of the roundtable discussion on dialysis economics at the First International Congress of Chinese Nephrologists 2015\". <i>Nephrology<\/i>. <b>22<\/b>: 3\u20138. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fnep.13143\" target=\"_blank\">10.1111\/nep.13143<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1440-1797\" target=\"_blank\">1440-1797<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29155495\" target=\"_blank\">29155495<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nephrology&rft.atitle=Addressing+the+burden+of+dialysis+around+the+world%3A+A+summary+of+the+roundtable+discussion+on+dialysis+economics+at+the+First+International+Congress+of+Chinese+Nephrologists+2015&rft.volume=22&rft.pages=3-8&rft.date=2017-12-01&rft.issn=1440-1797&rft_id=info%3Apmid%2F29155495&rft_id=info%3Adoi%2F10.1111%2Fnep.13143&rft.aulast=Li&rft.aufirst=Philip+Kam-Tao&rft.au=Lui%2C+Sing+Leung&rft.au=Ng%2C+Jack+Kit-Chung&rft.au=Cai%2C+Guan+Yan&rft.au=Chan%2C+Christopher+T&rft.au=Chen%2C+Hung+Chun&rft.au=Cheung%2C+Alfred+K&rft.au=Choi%2C+Koon+Shing&rft.au=Choong%2C+Hui+Lin&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-NYT-31\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-NYT_31-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-NYT_31-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Blakeslee, Sandra (12 February 2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.nytimes.com\/2009\/02\/13\/health\/13kolff.html?pagewanted=all\" target=\"_blank\">\"Willem Kolff, Doctor Who Invented Kidney and Heart Machines, Dies at 97\"<\/a>. <i>The New York Times<\/i>. New York Times.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Willem+Kolff%2C+Doctor+Who+Invented+Kidney+and+Heart+Machines%2C+Dies+at+97&rft.date=2009-02-12&rft.aulast=Blakeslee&rft.aufirst=Sandra&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2009%2F02%2F13%2Fhealth%2F13kolff.html%3Fpagewanted%3Dall&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"Bibliography\">Bibliography<\/span><\/h2>\n<div class=\"refbegin columns references-column-width\" style=\"-moz-column-width: 33em; -webkit-column-width: 33em; column-width: 33em;\">\n<ul><li><cite class=\"citation journal\">Al-Mosawi A. J. 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A.; Ali K. E.; Fadlalla A. E.; Khalid K. E. (2008). \"The effects of gum arabic oral treatment on the metabolic profile of chronic renal failure patients under regular haemodialysis in Central Sudan\". <i>Natural Product Research<\/i>. <b>22<\/b> (1): 12\u201321. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1080%2F14786410500463544\" target=\"_blank\">10.1080\/14786410500463544<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17999333\" target=\"_blank\">17999333<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Natural+Product+Research&rft.atitle=The+effects+of+gum+arabic+oral+treatment+on+the+metabolic+profile+of+chronic+renal+failure+patients+under+regular+haemodialysis+in+Central+Sudan&rft.volume=22&rft.issue=1&rft.pages=12-21&rft.date=2008&rft_id=info%3Adoi%2F10.1080%2F14786410500463544&rft_id=info%3Apmid%2F17999333&rft.au=Ali+A.+A.&rft.au=Ali+K.+E.&rft.au=Fadlalla+A.+E.&rft.au=Khalid+K.+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li>\n<li><cite class=\"citation journal\">Miskowiak J (1991). \"Continuous Intestinal Dialysis for Uraemia by Intermittent Oral Intake of Non-Absorbable Solutions: An Experimental Study\". <i>Scandinavian Journal of Urology and Nephrology<\/i>. <b>25<\/b> (1): 71\u201374. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.3109%2F00365599109024532\" target=\"_blank\">10.3109\/00365599109024532<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Scandinavian+Journal+of+Urology+and+Nephrology&rft.atitle=Continuous+Intestinal+Dialysis+for+Uraemia+by+Intermittent+Oral+Intake+of+Non-Absorbable+Solutions%3A+An+Experimental+Study&rft.volume=25&rft.issue=1&rft.pages=71-74&rft.date=1991&rft_id=info%3Adoi%2F10.3109%2F00365599109024532&rft.au=Miskowiak+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Further_reading\">Further reading<\/span><\/h2>\n<ul><li><cite id=\"rdp-ebb-CITEREFStefania_CrowtherLois_ReynoldsTilli_Tansey2009\" class=\"citation\">Stefania Crowther; Lois Reynolds; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tilli_Tansey\" title=\"Tilli Tansey\" rel=\"external_link\" target=\"_blank\">Tilli Tansey<\/a>, eds. (2009), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.histmodbiomed.org\/witsem\/vol37\" target=\"_blank\"><i>History of Dialysis in the UK: c. 1950-1980<\/i><\/a>, Wellcome Witnesses to Contemporary Medicine, <a href=\"https:\/\/en.wikipedia.org\/wiki\/History_of_Modern_Biomedicine_Research_Group\" title=\"History of Modern Biomedicine Research Group\" rel=\"external_link\" target=\"_blank\">History of Modern Biomedicine Research Group<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-85484-122-6<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=History+of+Dialysis+in+the+UK%3A+c.+1950-1980&rft.series=Wellcome+Witnesses+to+Contemporary+Medicine&rft.pub=History+of+Modern+Biomedicine+Research+Group&rft.date=2009&rft.isbn=978-0-85484-122-6&rft_id=http%3A%2F%2Fwww.histmodbiomed.org%2Fwitsem%2Fvol37&rfr_id=info%3Asid%2Fen.wikipedia.org%3ADialysis\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikidata\" title=\"Wikidata\" rel=\"external_link\" target=\"_blank\">Wikidata<\/a> <a href=\"https:\/\/www.wikidata.org\/wiki\/Q29581768\" class=\"extiw\" title=\"d:Q29581768\" rel=\"external_link\" target=\"_blank\">Q29581768<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=ZyEDAAAAMBAJ&pg=PA103#v=onepage&f=true\" target=\"_blank\">Machine Cleans Blood While You Wait<\/a>\u20141950 article on early use of dialysis machine at Bellevue Hospital New York City\u2014i.e. example of how complex and large early dialysis machines were<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.homedialysis.org\/home-dialysis-basics\/machines-and-supplies\/dialysis-museum\" target=\"_blank\">Home Dialysis Museum<\/a>\u2014History and pictures of dialysis machines through time<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.maximintegrated.com\/app-notes\/index.mvp\/id\/4698\" target=\"_blank\">Introduction to Dialysis Machines<\/a>\u2014Tutorial describing the main subfunctions of dialysis systems.<\/li>\n<li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cbc.ca\/news\/canada\/thunder-bay\/home-dialysis-1.3873291\" target=\"_blank\">First Nations man conducts own dialysis treatments to avoid move to the city<\/a>\u2014<a href=\"https:\/\/en.wikipedia.org\/wiki\/CBC_News\" title=\"CBC News\" rel=\"external_link\" target=\"_blank\">CBC News<\/a> (November 30, 2016)<\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1266\nCached time: 20181212175009\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.584 seconds\nReal time usage: 0.765 seconds\nPreprocessor visited node count: 2569\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 85124\/2097152 bytes\nTemplate argument size: 1165\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 5\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 80204\/5000000 bytes\nNumber of Wikibase entities loaded: 5\/400\nLua time usage: 0.303\/10.000 seconds\nLua memory usage: 6.66 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 628.836 1 -total\n<\/p>\n<pre>38.75% 243.674 1 Template:Reflist\n21.64% 136.086 1 Template:Cite_Q\n14.84% 93.333 13 Template:Cite_journal\n11.17% 70.220 3 Template:Cite_book\n10.37% 65.201 1 Template:Infobox_interventions\n 9.47% 59.574 1 Template:Infobox\n 7.61% 47.876 1 Template:About\n 6.80% 42.792 1 Template:Citation_needed\n 5.78% 36.327 1 Template:Fix\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:56511-1!canonical and timestamp 20181212175008 and revision id 873325604\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dialysis\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214659\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.044 seconds\nReal time usage: 0.210 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 200.255 1 - wikipedia:Dialysis\n100.00% 200.255 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8565-0!*!*!*!*!*!* and timestamp 20181217214659 and revision id 24993\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Dialysis\">https:\/\/www.limswiki.org\/index.php\/Dialysis<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","1015376d34b6db14e7bd61c81d508dc0_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c2\/Patient_receiving_dialysis_03.jpg\/560px-Patient_receiving_dialysis_03.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fc\/Hemodialysismachine.jpg\/440px-Hemodialysismachine.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ae\/Osmosis_Diffusion_Ultrafiltration_and_Dialysis.svg\/440px-Osmosis_Diffusion_Ultrafiltration_and_Dialysis.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/93\/Hemodialysis-en.svg\/1308px-Hemodialysis-en.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/4\/4e\/Peritoneal_dialysis.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d0\/Continuous_Venon_Venous_Haemofiltration_with_pre_and_post_dilution_%28CVVH%29.svg\/440px-Continuous_Venon_Venous_Haemofiltration_with_pre_and_post_dilution_%28CVVH%29.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/e7\/Continuous_Venon_Venous_HaemoDIALAfiltration_%28CVVHDF%29.svg\/440px-Continuous_Venon_Venous_HaemoDIALAfiltration_%28CVVHDF%29.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/54\/Dialysis_-_arm_-_01.jpg\/300px-Dialysis_-_arm_-_01.jpg"],"1015376d34b6db14e7bd61c81d508dc0_timestamp":1545083219,"6f55d1dae5110a6096abf37240670631_type":"article","6f55d1dae5110a6096abf37240670631_title":"Computer-assisted surgery","6f55d1dae5110a6096abf37240670631_url":"https:\/\/www.limswiki.org\/index.php\/Computer-assisted_surgery","6f55d1dae5110a6096abf37240670631_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tComputer-assisted surgery\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tComputer-assisted surgeryICD-9-CM00.3[edit on Wikidata]\nComputer-assisted surgery (CAS) represents a surgical concept and set of methods, that use computer technology for surgical planning, and for guiding or performing surgical interventions. CAS is also known as computer-aided surgery, computer-assisted intervention, image-guided surgery and surgical navigation, but these are terms that are more or less synonymous with CAS. CAS has been a leading factor in the development of robotic surgery.\n\nContents \n\n1 General principles \n\n1.1 Creating a virtual image of the patient \n1.2 Image analysis and processing \n1.3 Diagnostic, preoperative planning, surgical simulation \n1.4 Surgical navigation \n1.5 Robotic surgery \n\n\n2 Applications \n\n2.1 Computer-assisted neurosurgery \n2.2 Computer-assisted oral and maxillofacial surgery \n\n2.2.1 Guided Implantology \n\n\n2.3 Computer-assisted ENT surgery \n2.4 Computer-assisted orthopedic surgery (CAOS) \n2.5 Computer-assisted visceral surgery \n2.6 Computer-assisted cardiac interventions \n2.7 Computer-assisted radiosurgery \n\n\n3 Advantages \n4 Disadvantages \n5 See also \n6 References \n7 External links \n\n\nGeneral principles \n Image gathering (\"segmentation\") on the LUCAS workstation\nCreating a virtual image of the patient \nThe most important component for CAS is the development of an accurate model of the patient. This can be conducted through a number of medical imaging technologies including CT, MRI, x-rays, ultrasound plus many more. For the generation of this model, the anatomical region to be operated has to be scanned and uploaded into the computer system. It is possible to employ a number of scanning methods, with the datasets combined through data fusion techniques. The final objective is the creation of a 3D dataset that reproduces the exact geometrical situation of the normal and pathological tissues and structures of that region. Of the available scanning methods, the CT is preferred,[1] because MRI data sets are known to have volumetric deformations that may lead to inaccuracies. An example data set can include the collection of data compiled with 180 CT slices, that are 1 mm apart, each having 512 by 512 pixels. The contrasts of the 3D dataset (with its tens of millions of pixels) provide the detail of soft vs hard tissue structures, and thus allow a computer to differentiate, and visually separate for a human, the different tissues and structures. The image data taken from a patient will often include intentional landmark features, in order to be able to later realign the virtual dataset against the actual patient during surgery. See patient registration.\n\nImage analysis and processing \nImage analysis involves the manipulation of the patients 3D model to extract relevant information from the data. Using the differing contrast levels of the different tissues within the imagery, as examples, a model can be changed to show just hard structures such as bone, or view the flow of arteries and veins through the brain.\n\n Diagnostic, preoperative planning, surgical simulation \nUsing specialized software the gathered dataset can be rendered as a virtual 3D model of the patient, this model can be easily manipulated by a surgeon to provide views from any angle and at any depth within the volume. Thus the surgeon can better assess the case and establish a more accurate diagnostic. Furthermore, the surgical intervention will be planned and simulated virtually, before actual surgery takes place (computer-aided surgical simulation [CASS]). Using dedicated software, the surgical robot will be programmed to carry out the planned actions during the actual surgical intervention.\n\nSurgical navigation \nIn computer-assisted surgery, the actual intervention is defined as surgical navigation. Using the surgical navigation system the surgeon uses special instruments, which are tracked by the navigation system. The position of a tracked instrument in relation to the patient's anatomy is shown on images of the patient, as the surgeon moves the instrument. The surgeon thus uses the system to 'navigate' the location of an instrument. The feedback the system provides of the instrument location is particularly useful in situations where the surgeon cannot actually see the tip of the instrument, such as in minimally invasive surgeries.\n\nRobotic surgery \nMain article: Robotic surgery\nRobotic surgery is a term used for correlated actions of a surgeon and a surgical robot (that has been programmed to carry out certain actions during the preoperative planning procedure). A surgical robot is a mechanical device (generally looking like a robotic arm) that is computer-controlled.\nRobotic surgery can be divided into three types, depending on the degree of surgeon interaction during the procedure: supervisory-controlled, telesurgical, and shared-control.[2] In a supervisory-controlled system, the procedure is executed solely by the robot, which will perform the pre-programmed actions. A telesurgical system, also known as remote surgery, requires the surgeon to manipulate the robotic arms during the procedure rather than allowing the robotic arms to work from a predetermined program. With shared-control systems, the surgeon carries out the procedure with the use of a robot that offers steady-hand manipulations of the instrument. In most robots, the working mode can be chosen for each separate intervention, depending on the surgical complexity and the particularities of the case.\n\nApplications \nComputer-assisted surgery is the beginning of a revolution in surgery. It already makes a great difference in high-precision surgical domains, but it is also used in standard surgical procedures.\n\nComputer-assisted neurosurgery \nTelemanipulators have been used for the first time in neurosurgery, in the 1980s. This allowed a greater development in brain microsurgery (compensating surgeon\u2019s physiological tremor by 10-fold), increased accuracy and precision of the intervention. It also opened a new gate to minimally invasive brain surgery, furthermore reducing the risk of post-surgical morbidity by avoiding accidental damage to adjacent centers.\n\nComputer-assisted oral and maxillofacial surgery \nBone segment navigation is the modern surgical approach in orthognathic surgery (correction of the anomalies of the jaws and skull), in temporo-mandibular joint (TMJ) surgery, or in the reconstruction of the mid-face and orbit.[3]\nIt is also used in implantology where the available bone can be seen and the position, angulation and depth of the implants can be simulated before the surgery. During the operation surgeon is guided visually and by sound alerts. IGI (Image Guided Implantology) is one of the navigation systems which uses this technology.\n\nGuided Implantology \nNew therapeutic concepts as guided surgery are being developed and applied in the placement of dental implants. The prosthetic rehabilitation is also planned and performed parallel to the surgical procedures. The planning steps are at the foreground and carried out in a cooperation of the surgeon, the dentist and the dental technician. Edentulous patients, either one or both jaws, benefit as the time of treatment is reduced.\nRegarding the edentulous patients, conventional denture support is often compromised due to moderate bone atrophy, even if the dentures are constructed based on correct anatomic morphology.\nUsing cone beam computed tomography, the patient and the existing prosthesis are being scanned. Furthermore, the prosthesis alone is also scanned. Glass pearls of defined diameter are placed in the prosthesis and used as reference points for the upcoming planning. The resulting data is processed and the position of the implants determined. The surgeon, using special developed software, plans the implants based on prosthetic concepts considering the anatomic morphology. After the planning of the surgical part is completed, a CAD\/CAM surgical guide for dental placement is constructed. The mucosal-supported surgical splint ensures the exact placement of the implants in the patient. Parallel to this step, the new implant supported prosthesis is constructed.\nThe dental technician, using the data resulting from the previous scans, manufactures a model representing the situation after the implant placement. The prosthetic compounds, abutments, are already prefabricated. The length and the inclination can be chosen. The abutments are connected to the model at a position in consideration of the prosthetic situation. The exact position of the abutments is registered. The dental technician can now manufacture the prosthesis.\nThe fit of the surgical splint is clinically proved. After that, the splint is attached using a three-point support pin system. Prior to the attachment, irrigation with a chemical disinfectant is advised. The pins are driven through defined sheaths from the vestibular to the oral side of the jaw. Ligaments anatomy should be considered, and if necessary decompensation can be achieved with minimal surgical interventions. The proper fit of the template is crucial and should be maintained throughout the whole treatment. Regardless of the mucosal resilience, a correct and stable attachment is achieved through the bone fixation.\nThe access to the jaw can now only be achieved through the sleeves embedded in the surgical template. Using specific burs through the sleeves the mucosa is removed. Every bur used, carries a sleeve compatible to the sleeves in the template, which ensures that the final position is achieved but no further progress in the alveolar ridge can take place. Further procedure is very similar to the traditional implant placement. The pilot hole is drilled and then expanded. With the aid of the splint, the implants are finally placed. After that, the splint can be removed.\n\n<\/p>With the aid of a registration template, the abutments can be attached and connected to the implants at the defined position. No less than a pair of abutments should be connected simultaneously to avoid any discrepancy. An important advantage of this technique is the parallel positioning of the abutments. A radiological control is necessary to verify the correct placement and connection of implant and abutment.\nIn a further step, abutments are covered by gold cone caps, which represent the secondary crowns. Where necessary, the transition of the gold cone caps to the mucosa can be isolated with rubber dam rings.\nThe new prosthesis corresponds to a conventional total prosthesis but the basis contains cavities so that the secondary crowns can be incorporated. The prosthesis is controlled at the terminal position and corrected if needed. The cavities are filled with a self-curing cement and the prosthesis is placed in the terminal position. After the self-curing process, the gold caps are definitely cemented in the prosthesis cavities and the prosthesis can now be detached. Excess cement may be removed and some corrections like polishing or under filling around the secondary crowns may be necessary.\nThe new prosthesis is fitted using a construction of telescope double cone crowns. At the end position, the prosthesis buttons down on the abutments to ensure an adequate hold.\n\n<\/p>At the same sitting, the patient receives the implants and the prosthesis. An interim prosthesis is not necessary. The extent of the surgery is kept to minimum. Due to the application of the splint, a reflection of soft tissues in not needed. The patient experiences less bleeding, swelling and discomfort. Complications such as injuring of neighbouring structures are also avoided. \nUsing 3D imaging during the planning phase, the communication between the surgeon, dentist and dental technician is highly supported and any problems can easily detected and eliminated. Each specialist accompanies the whole treatment and interaction can be made. As the end result is already planned and all surgical intervention is carried according to the initial plan, the possibility of any deviation is kept to a minimum. Given the effectiveness of the initial planning the whole treatment duration is shorter than any other treatment procedures.\n\n<\/p>\nComputer-assisted ENT surgery \nImage-guided surgery and CAS in ENT commonly consists of navigating preoperative image data such as CT or cone beam CT to assist with locating or avoiding anatomically important regions such as the optical nerve or the opening to the frontal sinuses.[4] For use in middle-ear surgery there has been some application of robotic surgery due to the requirement for high-precision actions.[5]\n\n Computer-assisted orthopedic surgery (CAOS) \nThe application of robotic surgery is widespread in orthopedics, especially in routine interventions, like total hip replacement [6] or pedicle screw insertion.[7] It is also useful in pre-planning and guiding the correct anatomical position of displaced bone fragments in fractures, allowing a good fixation by osteosynthesis. Early CAOS systems include the HipNav, OrthoPilot, and Praxim.\n\nComputer-assisted visceral surgery \nWith the advent of computer-assisted surgery, great progresses have been made in general surgery towards minimal invasive approaches. Laparoscopy in abdominal and gynecologic surgery is one of the beneficiaries, allowing surgical robots to perform routine operations, like colecystectomies, or even hysterectomies. In cardiac surgery, shared control systems can perform mitral valve replacement or ventricular pacing by small thoracotomies. In urology, surgical robots contributed in laparoscopic approaches for pyeloplasty or nephrectomy or prostatic interventions.[8][9]\n\nComputer-assisted cardiac interventions \nApplications include atrial fibrillation and cardiac resynchronization therapy. Pre-operative MRI or CT is used to plan the procedure. Pre-operative images, models or planning information can be registered to intra-operative fluoroscopic image to guide procedures. \n\nComputer-assisted radiosurgery \nRadiosurgery is also incorporating advanced robotic systems. CyberKnife is such a system that has a lightweight linear accelerator mounted on the robotic arm. It is guided towards tumor processes, using the skeletal structures as a reference system (Stereotactic Radiosurgery System). During the procedure, real time X-ray is used to accurately position the device before delivering radiation beam. The robot can compensate for respiratory motion of the tumor in real-time.[10]\n\nAdvantages \nCAS starts with the premise of a much better visualization of the operative field, thus allowing a more accurate preoperative diagnostic and a well-defined surgical planning, by using surgical planning in a preoperative virtual environment. This way, the surgeon can easily assess most of the surgical difficulties and risks and have a clear idea about how to optimize the surgical approach and decrease surgical morbidity. During the operation, the computer guidance improves the geometrical accuracy of the surgical gestures and also reduce the redundancy of the surgeon\u2019s acts. This significantly improves ergonomy in the operating theatre, decreases the risk of surgical errors and reduces the operating time.\n\nDisadvantages \nThere are several disadvantages of computer-assisted surgery. A major disadvantage of this system is their cost. With a price tag of a million dollars[citation needed ], their cost is nearly prohibitive. Some people believe that improvements in technology, such as haptics, increased processor speeds, and more complex and capable software will increase the cost of these systems.[11] Another disadvantage is the size of these systems. These systems have relatively large footprints and relatively cumbersome robotic arms. This is an important disadvantage in today's already crowded-operating rooms. It may be difficult for both the surgical team and the robot to fit into the operating room.[11] Another factor that is stunting the development of robotic surgery is that of \u201clatency\u201d which is the time delay between the instructions issued by the surgeon and the movement of the robot which responds to the instructions. With the current level of technology, the surgeon must be in close proximity.[12]\n\nSee also \n\n\n Medicine portal \n Robotics portal \nAdvanced Simulation Library[13] is a hardware accelerated multiphysics simulation software\nReferences \n\n\n^ Mischkowski RA, Zinser MJ, Ritter L, Neugebauer J, Keeve E, Zoeller JE (2007b) Intraoperative navigation in the maxillofacial area based on 3D imaging obtained by a cone-beam device. Int J Oral Maxillofac Surg 36:687-694 \n\n^ Bale RJ, Melzer A et al.: Robotics for interventional procedures. Cardiovascular and Interventional Radiological Society of Europe Newsletter, 2006 \n\n^ Marmulla R, Niederdellmann H: Computer-assisted bone segment navigation. J Cranio-Maxillofac Surg 26:347-359, 1998 \n\n^ Surgical minimally-invasive endonasal tumor resection \n\n^ Berlinger NT:Robotic Surgery - Squeezing into Tight Places. New England Journal of Medicine 354:2099-2101, 2006 \n\n^ Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A: Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res 433:152-9, 2005 \n\n^ Manbachi A, Cobbold RS, Ginsberg HJ: \"Guided pedicle screw insertion: techniques and training.\" Spine J. 2014 Jan;14(1):165-79. \n\n^ Muntener M, Ursu D, Patriciu A, Petrisor D, Stoianovici D: Robotic prostate surgery. Expert Rev Med Devices 3(5):575-84 \n\n^ Guillonneau, Bertrand: What Robotics in Urology? A Current Point of View. European Urology. 43: 103-105 2003 \n\n^ Schweikard, A., Shiomi, H., & Adler, J. (2004). Respiration tracking in radiosurgery. Medical physics, 31(10), 2738-2741. \n\n^ a b Lanfranco, Anthony. \"Robotic Surgery: A Current Perspective\". \n\n^ \"Robotic Surgery \u2013 Advantages and Disadvantages\". \n\n^ \"ASL: Intraoperative Brain Shift Simulation\". \n\n\nExternal links \n Media related to Computer assisted surgery at Wikimedia Commons\n\nvteHealth softwareBarcoding\nBar Code Medication Administration\nDatabases\nEpocrates\nLexicomp\nMedscape\nMicromedex\nDiagnosticsBioimagingDICOMGeneral\n3DSlicer\nDrishti\nGIMIAS\nGinkgo CADx\nInVesalius\nITK-SNAP\nOsiriX\nVistA imaging\nVoreen\nXebra\nServers\nOrthanc\nXebra\nHeuristics\nBestbets\nCommonGround\nEuResist\nOdontologic\nCybermed\nFlorida Probe\nElectronic\r\nhealth recordsPlatforms\nApache cTAKES\nAHLTA\nathenaClinicals\nCentricity EMR\nCertify HealthLogix\nCerner EHR\nCottageMed\nCOSTAR\nDatix\nDocNetwork\nEMIAS\nEMIS Web\nEpicCare EMR\nFreeMED\nGaiaEHR\nGNUmed\nGPASS\nHOSxP\nINPS Vision\nKareo EHR\nMedcomSoft Record\nMTBC WebEHR2.0\nNextGen Healthcare\nNHS 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 16 August 2016, at 17:28.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 1,086 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","6f55d1dae5110a6096abf37240670631_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Computer-assisted_surgery skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Computer-assisted surgery<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Computer-assisted surgery<\/b> (<b>CAS<\/b>) represents a surgical concept and set of methods, that use computer technology for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_planning\" title=\"Surgical planning\" rel=\"external_link\" target=\"_blank\">surgical planning<\/a>, and for guiding or performing surgical interventions. CAS is also known as <b>computer-aided surgery<\/b>, <b>computer-assisted intervention<\/b>, <b>image-guided surgery<\/b> and <b>surgical navigation<\/b>, but these are terms that are more or less <a href=\"https:\/\/en.wikipedia.org\/wiki\/Synonym\" title=\"Synonym\" rel=\"external_link\" target=\"_blank\">synonymous<\/a> with CAS. CAS has been a leading factor in the development of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">robotic surgery<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"General_principles\">General principles<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:LUCASSegmentation1.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4a\/LUCASSegmentation1.jpg\/220px-LUCASSegmentation1.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:LUCASSegmentation1.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Image gathering (\"segmentation\") on the LUCAS workstation<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Creating_a_virtual_image_of_the_patient\">Creating a virtual image of the patient<\/span><\/h3>\n<p>The most important component for CAS is the development of an accurate model of the patient. This can be conducted through a number of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_imaging\" title=\"Medical imaging\" rel=\"external_link\" target=\"_blank\">medical imaging<\/a> technologies including <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography\" class=\"mw-redirect\" title=\"Computed tomography\" rel=\"external_link\" target=\"_blank\">CT<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-rays\" class=\"mw-redirect\" title=\"X-rays\" rel=\"external_link\" target=\"_blank\">x-rays<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasound\" title=\"Ultrasound\" rel=\"external_link\" target=\"_blank\">ultrasound<\/a> plus many more. For the generation of this model, the anatomical region to be operated has to be scanned and uploaded into the computer system. It is possible to employ a number of scanning methods, with the datasets combined through <a href=\"https:\/\/en.wikipedia.org\/wiki\/Data_fusion\" title=\"Data fusion\" rel=\"external_link\" target=\"_blank\">data fusion<\/a> techniques. The final objective is the creation of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Three-dimensional_space\" title=\"Three-dimensional space\" rel=\"external_link\" target=\"_blank\">3D<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dataset\" class=\"mw-redirect\" title=\"Dataset\" rel=\"external_link\" target=\"_blank\">dataset<\/a> that reproduces the exact geometrical situation of the normal and pathological tissues and structures of that region. Of the available scanning methods, the CT is preferred,<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> because MRI data sets are known to have volumetric deformations that may lead to inaccuracies. An example data set can include the collection of data compiled with 180 CT slices, that are 1 mm apart, each having 512 by 512 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pixels\" class=\"mw-redirect\" title=\"Pixels\" rel=\"external_link\" target=\"_blank\">pixels<\/a>. The contrasts of the 3D dataset (with its tens of millions of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pixels\" class=\"mw-redirect\" title=\"Pixels\" rel=\"external_link\" target=\"_blank\">pixels<\/a>) provide the detail of soft vs hard tissue structures, and thus allow a computer to differentiate, and visually separate for a human, the different tissues and structures. The image data taken from a patient will often include intentional landmark features, in order to be able to later realign the virtual dataset against the actual patient during surgery. See <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_registration\" title=\"Patient registration\" rel=\"external_link\" target=\"_blank\">patient registration<\/a>.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Image_analysis_and_processing\">Image analysis and processing<\/span><\/h3>\n<p>Image analysis involves the manipulation of the patients 3D model to extract relevant information from the data. Using the differing contrast levels of the different tissues within the imagery, as examples, a model can be changed to show just hard structures such as bone, or view the flow of arteries and veins through the brain.\n<\/p>\n<h3><span id=\"rdp-ebb-Diagnostic.2C_preoperative_planning.2C_surgical_simulation\"><\/span><span class=\"mw-headline\" id=\"Diagnostic,_preoperative_planning,_surgical_simulation\">Diagnostic, preoperative planning, surgical simulation<\/span><\/h3>\n<p>Using specialized software the gathered dataset can be rendered as a virtual 3D model of the patient, this model can be easily manipulated by a surgeon to provide views from any angle and at any depth within the volume. Thus the surgeon can better assess the case and establish a more accurate diagnostic. Furthermore, the surgical intervention will be planned and simulated virtually, before actual surgery takes place (computer-aided surgical simulation [CASS]). Using dedicated software, the surgical robot will be programmed to carry out the planned actions during the actual surgical intervention.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Surgical_navigation\">Surgical navigation<\/span><\/h3>\n<p>In computer-assisted surgery, the actual intervention is defined as surgical navigation. Using the surgical navigation system the surgeon uses special instruments, which are tracked by the navigation system. The position of a tracked instrument in relation to the patient's anatomy is shown on images of the patient, as the surgeon moves the instrument. The surgeon thus uses the system to 'navigate' the location of an instrument. The feedback the system provides of the instrument location is particularly useful in situations where the surgeon cannot actually see the tip of the instrument, such as in minimally invasive surgeries.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Robotic_surgery\">Robotic surgery<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_surgery\" class=\"mw-redirect\" title=\"Robotic surgery\" rel=\"external_link\" target=\"_blank\">Robotic surgery<\/a><\/div>\n<p>Robotic surgery is a term used for correlated actions of a surgeon and a surgical robot (that has been programmed to carry out certain actions during the preoperative planning procedure). A surgical robot is a mechanical device (generally looking like a robotic arm) that is computer-controlled.\nRobotic surgery can be divided into three types, depending on the degree of surgeon interaction during the procedure: supervisory-controlled, telesurgical, and shared-control.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> In a supervisory-controlled system, the procedure is executed solely by the robot, which will perform the pre-programmed actions. A telesurgical system, also known as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_surgery\" title=\"Remote surgery\" rel=\"external_link\" target=\"_blank\">remote surgery<\/a>, requires the surgeon to manipulate the robotic arms during the procedure rather than allowing the robotic arms to work from a predetermined program. With shared-control systems, the surgeon carries out the procedure with the use of a robot that offers steady-hand manipulations of the instrument. In most robots, the working mode can be chosen for each separate intervention, depending on the surgical complexity and the particularities of the case.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>Computer-assisted surgery is the beginning of a revolution in surgery. It already makes a great difference in high-precision surgical domains, but it is also used in standard surgical procedures.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Computer-assisted_neurosurgery\">Computer-assisted neurosurgery<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_manipulator\" title=\"Remote manipulator\" rel=\"external_link\" target=\"_blank\">Telemanipulators<\/a> have been used for the first time in neurosurgery, in the 1980s. This allowed a greater development in brain microsurgery (compensating surgeon\u2019s physiological tremor by 10-fold), increased accuracy and precision of the intervention. It also opened a new gate to minimally invasive brain surgery, furthermore reducing the risk of post-surgical morbidity by avoiding accidental damage to adjacent centers.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Computer-assisted_oral_and_maxillofacial_surgery\">Computer-assisted oral and maxillofacial surgery<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_segment_navigation\" title=\"Bone segment navigation\" rel=\"external_link\" target=\"_blank\">Bone segment navigation<\/a> is the modern surgical approach in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthognathic_surgery\" title=\"Orthognathic surgery\" rel=\"external_link\" target=\"_blank\">orthognathic surgery<\/a> (correction of the anomalies of the jaws and skull), in <a href=\"https:\/\/en.wikipedia.org\/wiki\/TMJ\" class=\"mw-redirect\" title=\"TMJ\" rel=\"external_link\" target=\"_blank\">temporo-mandibular joint (TMJ)<\/a> surgery, or in the reconstruction of the mid-face and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orbit_(anatomy)\" title=\"Orbit (anatomy)\" rel=\"external_link\" target=\"_blank\">orbit<\/a>.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>It is also used in implantology where the available bone can be seen and the position, angulation and depth of the implants can be simulated before the surgery. During the operation surgeon is guided visually and by sound alerts. IGI (Image Guided Implantology) is one of the navigation systems which uses this technology.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Guided_Implantology\">Guided Implantology<\/span><\/h4>\n<p>New therapeutic concepts as guided surgery are being developed and applied in the placement of dental implants. The prosthetic rehabilitation is also planned and performed parallel to the surgical procedures. The planning steps are at the foreground and carried out in a cooperation of the surgeon, the dentist and the dental technician. Edentulous patients, either one or both jaws, benefit as the time of treatment is reduced.\n<\/p><p>Regarding the edentulous patients, conventional denture support is often compromised due to moderate bone atrophy, even if the dentures are constructed based on correct anatomic morphology.\n<\/p><p>Using cone beam computed tomography, the patient and the existing prosthesis are being scanned. Furthermore, the prosthesis alone is also scanned. Glass pearls of defined diameter are placed in the prosthesis and used as reference points for the upcoming planning. The resulting data is processed and the position of the implants determined. The surgeon, using special developed software, plans the implants based on prosthetic concepts considering the anatomic morphology. After the planning of the surgical part is completed, a CAD\/CAM surgical guide for dental placement is constructed. The mucosal-supported surgical splint ensures the exact placement of the implants in the patient. Parallel to this step, the new implant supported prosthesis is constructed.\n<\/p><p>The dental technician, using the data resulting from the previous scans, manufactures a model representing the situation after the implant placement. The prosthetic compounds, abutments, are already prefabricated. The length and the inclination can be chosen. The abutments are connected to the model at a position in consideration of the prosthetic situation. The exact position of the abutments is registered. The dental technician can now manufacture the prosthesis.\n<\/p><p>The fit of the surgical splint is clinically proved. After that, the splint is attached using a three-point support pin system. Prior to the attachment, irrigation with a chemical disinfectant is advised. The pins are driven through defined sheaths from the vestibular to the oral side of the jaw. Ligaments anatomy should be considered, and if necessary decompensation can be achieved with minimal surgical interventions. The proper fit of the template is crucial and should be maintained throughout the whole treatment. Regardless of the mucosal resilience, a correct and stable attachment is achieved through the bone fixation.\n<p>The access to the jaw can now only be achieved through the sleeves embedded in the surgical template. Using specific burs through the sleeves the mucosa is removed. Every bur used, carries a sleeve compatible to the sleeves in the template, which ensures that the final position is achieved but no further progress in the alveolar ridge can take place. Further procedure is very similar to the traditional implant placement. The pilot hole is drilled and then expanded. With the aid of the splint, the implants are finally placed. After that, the splint can be removed.\n<\/p>\n<\/p><p>With the aid of a registration template, the abutments can be attached and connected to the implants at the defined position. No less than a pair of abutments should be connected simultaneously to avoid any discrepancy. An important advantage of this technique is the parallel positioning of the abutments. A radiological control is necessary to verify the correct placement and connection of implant and abutment.\n<\/p><p>In a further step, abutments are covered by gold cone caps, which represent the secondary crowns. Where necessary, the transition of the gold cone caps to the mucosa can be isolated with rubber dam rings.\n<\/p><p>The new prosthesis corresponds to a conventional total prosthesis but the basis contains cavities so that the secondary crowns can be incorporated. The prosthesis is controlled at the terminal position and corrected if needed. The cavities are filled with a self-curing cement and the prosthesis is placed in the terminal position. After the self-curing process, the gold caps are definitely cemented in the prosthesis cavities and the prosthesis can now be detached. Excess cement may be removed and some corrections like polishing or under filling around the secondary crowns may be necessary.\n<p>The new prosthesis is fitted using a construction of telescope double cone crowns. At the end position, the prosthesis buttons down on the abutments to ensure an adequate hold.\n<\/p>\n<\/p><p>At the same sitting, the patient receives the implants and the prosthesis. An interim prosthesis is not necessary. The extent of the surgery is kept to minimum. Due to the application of the splint, a reflection of soft tissues in not needed. The patient experiences less bleeding, swelling and discomfort. Complications such as injuring of neighbouring structures are also avoided. \n<p>Using 3D imaging during the planning phase, the communication between the surgeon, dentist and dental technician is highly supported and any problems can easily detected and eliminated. Each specialist accompanies the whole treatment and interaction can be made. As the end result is already planned and all surgical intervention is carried according to the initial plan, the possibility of any deviation is kept to a minimum. Given the effectiveness of the initial planning the whole treatment duration is shorter than any other treatment procedures.\n<\/p>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Computer-assisted_ENT_surgery\">Computer-assisted ENT surgery<\/span><\/h3>\n<p>Image-guided surgery and CAS in ENT commonly consists of navigating preoperative image data such as CT or cone beam CT to assist with locating or avoiding anatomically important regions such as the optical nerve or the opening to the frontal sinuses.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> For use in middle-ear surgery there has been some application of robotic surgery due to the requirement for high-precision actions.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h3><span id=\"rdp-ebb-Computer-assisted_orthopedic_surgery_.28CAOS.29\"><\/span><span class=\"mw-headline\" id=\"Computer-assisted_orthopedic_surgery_(CAOS)\">Computer-assisted orthopedic surgery (CAOS)<\/span><\/h3>\n<p>The application of robotic surgery is widespread in orthopedics, especially in routine interventions, like total <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hip_replacement\" title=\"Hip replacement\" rel=\"external_link\" target=\"_blank\">hip replacement<\/a> <sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pedicle_of_vertebral_arch\" class=\"mw-redirect\" title=\"Pedicle of vertebral arch\" rel=\"external_link\" target=\"_blank\">pedicle<\/a> screw insertion.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> It is also useful in pre-planning and guiding the correct anatomical position of displaced bone fragments in fractures, allowing a good fixation by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Osteosynthesis\" title=\"Osteosynthesis\" rel=\"external_link\" target=\"_blank\">osteosynthesis<\/a>. Early CAOS systems include the <a href=\"https:\/\/en.wikipedia.org\/wiki\/HipNav\" title=\"HipNav\" rel=\"external_link\" target=\"_blank\">HipNav<\/a>, , and Praxim.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Computer-assisted_visceral_surgery\">Computer-assisted visceral surgery<\/span><\/h3>\n<p>With the advent of computer-assisted surgery, great progresses have been made in general surgery towards minimal invasive approaches. Laparoscopy in abdominal and gynecologic surgery is one of the beneficiaries, allowing surgical robots to perform routine operations, like colecystectomies, or even hysterectomies. In cardiac surgery, shared control systems can perform mitral valve replacement or ventricular pacing by small thoracotomies. In urology, surgical robots contributed in laparoscopic approaches for pyeloplasty or nephrectomy or prostatic interventions.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Computer-assisted_cardiac_interventions\">Computer-assisted cardiac interventions<\/span><\/h3>\n<p>Applications include atrial fibrillation and cardiac resynchronization therapy. Pre-operative MRI or CT is used to plan the procedure. Pre-operative images, models or planning information can be registered to intra-operative fluoroscopic image to guide procedures. \n<\/p>\n<h3><span class=\"mw-headline\" id=\"Computer-assisted_radiosurgery\">Computer-assisted radiosurgery<\/span><\/h3>\n<p>Radiosurgery is also incorporating advanced robotic systems. <a href=\"https:\/\/en.wikipedia.org\/wiki\/CyberKnife\" class=\"mw-redirect\" title=\"CyberKnife\" rel=\"external_link\" target=\"_blank\">CyberKnife<\/a> is such a system that has a lightweight linear accelerator mounted on the robotic arm. It is guided towards tumor processes, using the skeletal structures as a reference system (Stereotactic Radiosurgery System). During the procedure, real time X-ray is used to accurately position the device before delivering radiation beam. The robot can compensate for respiratory motion of the tumor in real-time.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Advantages\">Advantages<\/span><\/h2>\n<p>CAS starts with the premise of a much better visualization of the operative field, thus allowing a more accurate preoperative diagnostic and a well-defined surgical planning, by using surgical planning in a preoperative <a href=\"https:\/\/en.wikipedia.org\/wiki\/Virtual_environment\" title=\"Virtual environment\" rel=\"external_link\" target=\"_blank\">virtual environment<\/a>. This way, the surgeon can easily assess most of the surgical difficulties and risks and have a clear idea about how to optimize the surgical approach and decrease surgical morbidity. During the operation, the computer guidance improves the geometrical accuracy of the surgical gestures and also reduce the redundancy of the surgeon\u2019s acts. This significantly improves <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ergonomy\" class=\"mw-redirect\" title=\"Ergonomy\" rel=\"external_link\" target=\"_blank\">ergonomy<\/a> in the operating theatre, decreases the risk of surgical errors and reduces the operating time.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Disadvantages\">Disadvantages<\/span><\/h2>\n<p>There are several disadvantages of computer-assisted surgery. A major disadvantage of this system is their cost. With a price tag of a million dollars<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (September 2016)\">citation needed<\/span><\/a><\/i>]<\/sup>, their cost is nearly prohibitive. Some people believe that improvements in technology, such as haptics, increased processor speeds, and more complex and capable software will increase the cost of these systems.<sup id=\"rdp-ebb-cite_ref-test_11-0\" class=\"reference\"><a href=\"#cite_note-test-11\" rel=\"external_link\">[11]<\/a><\/sup> Another disadvantage is the size of these systems. These systems have relatively large footprints and relatively cumbersome robotic arms. This is an important disadvantage in today's already crowded-operating rooms. It may be difficult for both the surgical team and the robot to fit into the operating room.<sup id=\"rdp-ebb-cite_ref-test_11-1\" class=\"reference\"><a href=\"#cite_note-test-11\" rel=\"external_link\">[11]<\/a><\/sup> Another factor that is stunting the development of robotic surgery is that of \u201clatency\u201d which is the time delay between the instructions issued by the surgeon and the movement of the robot which responds to the instructions. With the current level of technology, the surgeon must be in close proximity.<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<div role=\"navigation\" aria-label=\"Portals\" class=\"noprint portal plainlist tright\" style=\"margin:0.5em 0 0.5em 1em;border:solid #aaa 1px\">\n<ul style=\"display:table;box-sizing:border-box;padding:0.1em;max-width:175px;background:#f9f9f9;font-size:85%;line-height:110%;font-style:italic;font-weight:bold\">\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><img alt=\"icon\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/WHO_Rod.svg\/12px-WHO_Rod.svg.png\" width=\"12\" height=\"28\" class=\"noviewer\" \/><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Medicine\" title=\"Portal:Medicine\" rel=\"external_link\" target=\"_blank\">Medicine portal<\/a><\/span><\/li>\n<li style=\"display:table-row\"><span style=\"display:table-cell;padding:0.2em;vertical-align:middle;text-align:center\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Animation2.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"icon\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c0\/Animation2.gif\/17px-Animation2.gif\" width=\"17\" height=\"28\" class=\"noviewer\" \/><\/a><\/span><span style=\"display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Portal:Robotics\" title=\"Portal:Robotics\" rel=\"external_link\" target=\"_blank\">Robotics portal<\/a><\/span><\/li><\/ul><\/div>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Advanced_Simulation_Library\" title=\"Advanced Simulation Library\" rel=\"external_link\" target=\"_blank\">Advanced Simulation Library<\/a><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup> is a hardware accelerated multiphysics simulation software<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Mischkowski RA, Zinser MJ, Ritter L, Neugebauer J, Keeve E, Zoeller JE (2007b) Intraoperative navigation in the maxillofacial area based on 3D imaging obtained by a cone-beam device. Int J Oral Maxillofac Surg 36:687-694<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Bale RJ, Melzer A et al.: <i>Robotics for interventional procedures.<\/i> Cardiovascular and Interventional Radiological Society of Europe Newsletter, 2006<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Marmulla R, Niederdellmann H: <i>Computer-assisted bone segment navigation.<\/i> J Cranio-Maxillofac Surg 26:347-359, 1998<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.scopis.com\/en\/news\/navigation-in-practice\/details\/archive\/2013\/january\/22\/article\/scopisR-navigation-in-der-praxis-minimal-invasive-endonasale-tumorentfernung\/\" target=\"_blank\">Surgical minimally-invasive endonasal tumor resection<\/a><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Berlinger NT:<i>Robotic Surgery - Squeezing into Tight Places<\/i>. New England Journal of Medicine 354:2099-2101, 2006<\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A: <i>Computer-assisted navigation increases precision of component placement in total knee arthroplasty.<\/i> Clin Orthop Relat Res 433:152-9, 2005<\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Manbachi A, Cobbold RS, Ginsberg HJ: \"Guided pedicle screw insertion: techniques and training.\" Spine J. 2014 Jan;14(1):165-79.<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Muntener M, Ursu D, Patriciu A, Petrisor D, Stoianovici D: <i>Robotic prostate surgery.<\/i> Expert Rev Med Devices 3(5):575-84<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Guillonneau, Bertrand: <i>What Robotics in Urology? A Current Point of View.<\/i> European Urology. 43: 103-105 2003<\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Schweikard, A., Shiomi, H., & Adler, J. (2004). Respiration tracking in radiosurgery. Medical physics, 31(10), 2738-2741.<\/span>\n<\/li>\n<li id=\"cite_note-test-11\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-test_11-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-test_11-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Lanfranco, Anthony. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.medscape.com\/viewarticle\/466691_5\" target=\"_blank\">\"Robotic Surgery: A Current Perspective\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Robotic+Surgery%3A+A+Current+Perspective&rft.aulast=Lanfranco&rft.aufirst=Anthony&rft_id=http%3A%2F%2Fwww.medscape.com%2Fviewarticle%2F466691_5&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComputer-assisted+surgery\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.futuretechnology500.com\/index.php\/future-medical-technology\/robotic-surgery-advantages-and-disadvantages\/\" target=\"_blank\">\"Robotic Surgery \u2013 Advantages and Disadvantages\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Robotic+Surgery+%E2%80%93+Advantages+and+Disadvantages&rft_id=http%3A%2F%2Fwww.futuretechnology500.com%2Findex.php%2Ffuture-medical-technology%2Frobotic-surgery-advantages-and-disadvantages%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComputer-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/asl.org.il\/2015\/08\/30\/ASL_assists_neurosurgeons\/\" target=\"_blank\">\"ASL: Intraoperative Brain Shift Simulation\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=ASL%3A+Intraoperative+Brain+Shift+Simulation&rft_id=http%3A%2F%2Fasl.org.il%2F2015%2F08%2F30%2FASL_assists_neurosurgeons%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComputer-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Commons-logo.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/12px-Commons-logo.svg.png\" width=\"12\" height=\"16\" class=\"noviewer\" \/><\/a> Media related to <a href=\"https:\/\/commons.wikimedia.org\/wiki\/Category:Computer_assisted_surgery\" class=\"extiw\" title=\"commons:Category:Computer assisted surgery\" rel=\"external_link\" target=\"_blank\">Computer assisted surgery <\/a> at Wikimedia Commons\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1324\nCached time: 20181217045410\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.332 seconds\nReal time usage: 0.455 seconds\nPreprocessor visited node count: 973\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 58702\/2097152 bytes\nTemplate argument size: 863\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 11289\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.151\/10.000 seconds\nLua memory usage: 5.1 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 365.561 1 -total\n<\/p>\n<pre>26.45% 96.695 1 Template:Reflist\n23.65% 86.440 1 Template:Infobox_interventions\n21.37% 78.105 1 Template:Infobox\n20.62% 75.375 3 Template:Cite_web\n17.12% 62.575 1 Template:Commons_category-inline\n14.13% 51.667 1 Template:Citation_needed\n13.69% 50.043 7 Template:Navbox\n12.41% 45.352 1 Template:Fix\n 8.75% 31.978 1 Template:Health_software\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:15945619-1!canonical and timestamp 20181217045410 and revision id 825174313\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-assisted_surgery\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214658\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.151 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 144.345 1 - wikipedia:Computer-assisted_surgery\n100.00% 144.345 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8301-0!*!*!*!*!*!* and timestamp 20181217214658 and revision id 27023\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Computer-assisted_surgery\">https:\/\/www.limswiki.org\/index.php\/Computer-assisted_surgery<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","6f55d1dae5110a6096abf37240670631_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/4\/4a\/LUCASSegmentation1.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c0\/Animation2.gif\/34px-Animation2.gif","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/24px-Commons-logo.svg.png"],"6f55d1dae5110a6096abf37240670631_timestamp":1545083218,"7dae9d41420f015e1fc21b33951b5110_type":"article","7dae9d41420f015e1fc21b33951b5110_title":"Coronary catheterization","7dae9d41420f015e1fc21b33951b5110_url":"https:\/\/www.limswiki.org\/index.php\/Coronary_catheterization","7dae9d41420f015e1fc21b33951b5110_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCoronary catheterization\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tCoronary catheterizationA coronary angiogram (an X-ray with radiocontrast agent in the coronary arteries) that shows the left coronary circulation. The distal left main coronary artery (LMCA) is in the left upper quadrant of the image. Its main branches (also visible) are the left circumflex artery (LCX), which courses top-to-bottom initially and then toward the centre\/bottom, and the left anterior descending (LAD) artery, which courses from left-to-right on the image and then down the middle of the image to project underneath the distal LCX. The LAD, as is usual, has two large diagonal branches, which arise at the centre-top of the image and course toward the centre\/right of the image.[edit on Wikidata]\nA coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. It is performed for both diagnostic and interventional (treatment) purposes.\nCoronary catheterization is one of the several cardiology diagnostic tests and procedures. Specifically, coronary catheterization is a visually interpreted test performed to recognize occlusion, stenosis, restenosis, thrombosis or aneurysmal enlargement of the coronary artery lumens; heart chamber size; heart muscle contraction performance; and some aspects of heart valve function. Important internal heart and lung blood pressures, not measurable from outside the body, can be accurately measured during the test. The relevant problems that the test deals with most commonly occur as a result of advanced atherosclerosis \u2013 atheroma activity within the wall of the coronary arteries. Less frequently, valvular, heart muscle, or arrhythmia issues are the primary focus of the test.\nCoronary artery luminal narrowing reduces the flow reserve for oxygenated blood to the heart, typically producing intermittent angina. Very advanced luminal occlusion usually produces a heart attack. However, it has been increasingly recognized, since the late 1980s, that coronary catheterization does not allow the recognition of the presence or absence of coronary atherosclerosis itself, only significant luminal changes which have occurred as a result of end stage complications of the atherosclerotic process. See IVUS and atheroma for a better understanding of this issue.\n\nContents \n\n1 History \n2 Indications \n3 Patient participation \n4 Equipment \n5 Diagnostic procedures \n6 Therapeutic procedures \n7 Advances in catheter based physical treatments \n8 Alternative approaches \n9 See also \n10 References \n\n10.1 Notes \n10.2 General \n\n\n\n\nHistory \nMain article: History of invasive and interventional cardiology\nThe technique of angiography itself was first developed in 1927 by the Portuguese physician Egas Moniz at the University of Lisbon for cerebral angiography, the viewing of brain vasculature by X-ray radiation with the aid of a contrast medium introduced by catheter.\nHeart catheterization was first performed in 1929 when the German physician Werner Forssmann inserted a plastic tube in his cubital vein and guided it to the right chamber of the heart. He took an x-ray to prove his success and published it on November 5, 1929 with the title \"\u00dcber die Sondierung des rechten Herzens\" (About probing of the right heart).\nIn the early 1940s, Andr\u00e9 Cournand, in collaboration with Dickinson Richards, performed more systematic measurements of the hemodynamics of the heart. For their work in the discovery of cardiac catheterization and hemodynamic measurements, Cournand, Forssmann, and Richards shared the Nobel Prize in Physiology or Medicine in 1956. The first radial access for angiography can be traced back to 1953, where Eduardo Pereira, in Lisbon, Portugal, first cannulated the radial artery to perform a coronary angiogram. \nIn 1960 F. Mason Sones, a pediatric cardiologist at the Cleveland Clinic, accidentally injected radiocontrast in a coronary artery instead of the left ventricle. Although the patient had a reversible cardiac arrest, Sones and Shirey developed the procedure further, and are credited with the discovery (Connolly 2002); they published a series of 1,000 patents in 1966 (Proudfit et al.).\nSince the late 1970s, building on the pioneering work of Charles Dotter in 1964 and especially Andreas Gruentzig starting in 1977, coronary catheterization has been extended to therapeutic uses: (a) the performance of less invasive physical treatment for angina and some of the complications of severe atherosclerosis, (b) treating heart attacks before complete damage has occurred and (c) research for better understanding of the pathology of coronary artery disease and atherosclerosis.\nIn the early 1960s, cardiac catheterization frequently took several hours and involved significant complications for as many as 2\u20133% of patients. With multiple incremental improvements over time, simple coronary catheterization examinations are now commonly done more rapidly and with significantly improved outcomes.\n\nIndications \nIndications for cardiac catheterization include the following:\n\nHeart Attack (includes ST elevation MI, Non-ST Elevation MI, Unstable Angina)\nAbnormal Stress Test\nNew-onset unexplained heart failure\nSurvival of sudden cardiac death or dangerous cardiac arrhythmia\nPersistent chest pain despite optimal medical therapy\nWorkup of suspected Prinzmetal Angina (coronary vasospasm)[1]\nPatient participation \n Coronary Angiography.\nThe patient being examined or treated is usually awake during catheterization, ideally with only local anaesthesia such as lidocaine and minimal general sedation, throughout the procedure. Performing the procedure with the patient awake is safer as the patient can immediately report any discomfort or problems and thereby facilitate rapid correction of any undesirable events. Medical monitors fail to give a comprehensive view of the patient's immediate well-being; how the patient feels is often a most reliable indicator of procedural safety.\nDeath, myocardial infarction, stroke, serious ventricular arrhythmia, and major vascular complications each occur in less than 1% of patients undergoing catheterization.[2] However, though the imaging portion of the examination is often brief, because of setup and safety issues the patient is often in the lab for 20\u201345 minutes. Any of multiple technical difficulties, while not endangering the patient (indeed added to protect the patient's interests) can significantly increase the examination time.\n\nEquipment \nCoronary catheterization is performed in a catheterization lab, usually located within a hospital. With current designs, the patient must lie relatively flat on a narrow, minimally padded, radiolucent (transparent to X-ray) table. The X-ray source and imaging camera equipment are on opposite sides of the patient's chest and freely move, under motorized control, around the patient's chest so images can be taken quickly from multiple angles. More advanced equipment, termed a bi-plane cath lab, uses two sets of X-ray source and imaging cameras, each free to move independently, which allows two sets of images to be taken with each injection of radiocontrast agent. The equipment and installation setup to perform such testing typically represents a capital expenditure of US$2\u20135 million (2004), sometimes more, partially repeated every few years.\n\nDiagnostic procedures \n Coronary angiography of a critical sub-occlusion of the common trunk of the left coronary artery and the circumflex artery. (See arrows)\nDuring coronary catheterization (often referred to as a cath by physicians), blood pressures are recorded and X-ray motion picture shadow-grams of the blood inside the coronary arteries are recorded. In order to create the X-ray pictures, a physician guides a small tube-like device called a catheter, typically ~2.0 mm (6-French) in diameter, through the large arteries of the body until the tip is just within the opening of one of the coronary arteries. By design, the catheter is smaller than the lumen of the artery it is placed in; internal (intra-arterial) blood pressures are monitored through the catheter to verify that the catheter does not block blood flow.\nThe catheter is itself designed to be radiodense for visibility and it allows a clear, watery, blood compatible radiocontrast agent, commonly called an X-ray dye, to be selectively injected and mixed with the blood flowing within the artery. Typically 3\u20138 cc of the radiocontrast agent is injected for each image to make the blood flow visible for about 3\u20135 seconds as the radiocontrast agent is rapidly washed away into the coronary capillaries and then coronary veins. Without the X-ray dye injection, the blood and surrounding heart tissues appear, on X-ray, as only a mildly-shape-changing, otherwise uniform water density mass; no details of the blood and internal organ structure are discernible. The radiocontrast within the blood allows visualization of the blood flow within the arteries or heart chambers, depending on where it is injected.\nIf atheroma, or clots, are protruding into the lumen, producing narrowing, the narrowing may be seen instead as increased haziness within the X-ray shadow images of the blood\/dye column within that portion of the artery; this is as compared to adjacent, presumed healthier, less stenotic areas. See the single frame illustration of a coronary angiogram image on the angioplasty page.\nFor guidance regarding catheter positions during the examination, the physician mostly relies on detailed knowledge of internal anatomy, guide wire and catheter behavior and intermittently, briefly uses fluoroscopy and a low X-ray dose to visualize when needed. This is done without saving recordings of these brief looks. When the physician is ready to record diagnostic views, which are saved and can be more carefully scrutinized later, he activates the equipment to apply a significantly higher X-ray dose, termed cine, in order to create better quality motion picture images, having sharper radiodensity contrast, typically at 30 frames per second. The physician controls both the contrast injection, fluoroscopy and cine application timing so as to minimize the total amount of radiocontrast injected and times the X-Ray to the injection so as to minimize the total amount of X-ray used. Doses of radiocontrast agents and X-ray exposure times are routinely recorded in an effort to maximize safety.\nThough not the focus of the test, calcification within the artery walls, located in the outer edges of atheroma within the artery walls, is sometimes recognizable on fluoroscopy (without contrast injection) as radiodense halo rings partially encircling, and separated from the blood filled lumen by the interceding radiolucent atheroma tissue and endothelial lining. Calcification, even though usually present, is usually only visible when quite advanced and calcified sections of the artery wall happen to be viewed on end tangentially through multiple rings of calcification, so as to create enough radiodensity to be visible on fluoroscopy.\n\nTherapeutic procedures \nMain article: Percutaneous coronary intervention\nBy changing the diagnostic catheter to a guiding catheter, physicians can also pass a variety of instruments through the catheter and into the artery to a lesion site. The most commonly used are 0.014-inch-diameter (0.36 mm) guide wires and the balloon dilation catheters.\nBy injecting radiocontrast agent through a tiny passage extending down the balloon catheter and into the balloon, the balloon is progressively expanded. The hydraulic pressures are chosen and applied by the physician, according to how the balloon within the stenosis (abnormal narrowing in a blood vessel) responds. The radiocontrast filled balloon is watched under fluoroscopy (it typically assumes a \"dog bone\" shape imposed on the outside of the balloon by the stenosis as the balloon is expanded), as it opens. As much hydraulic brute force is applied as judged needed and visualized to be effective to make the stenosis of the artery lumen visibly enlarge.\nTypical normal coronary artery pressures are in the <200 mmHg range (27 kPa). The hydraulic pressures applied within the balloon may extend to as high as 19000 mmHg (2,500 kPa). Prevention of over-enlargement is achieved by choosing balloons manufactured out of high tensile strength clear plastic membranes. The balloon is initially folded around the catheter, near the tip, to create a small cross-sectional profile to facilitate passage though luminal stenotic areas, and is designed to inflate to a specific pre-designed diameter. If over inflated, the balloon material simply tears and allows the inflating radiocontrast agent to simply escape into the blood.\nAdditionally, several other devices can be advanced into the artery via a guiding catheter. These include laser catheters, stent catheters, IVUS catheters, Doppler catheter, pressure or temperature measurement catheter and various clot and grinding or removal devices. Most of these devices have turned out to be niche devices, only useful in a small percentage of situations or for research.\nStents, which are specially manufactured expandable stainless steel mesh tubes, mounted on a balloon catheter, are the most commonly used device beyond the balloon catheter. When the stent\/balloon device is positioned within the stenosis, the balloon is inflated which, in turn, expands the stent and the artery. The balloon is removed and the stent remains in place, supporting the inner artery walls in the more open, dilated position. Current stents generally cost around $1,000 to 3,000 each (US 2004 dollars), the drug coated ones being the more expensive.\n\nAdvances in catheter based physical treatments \nInterventional procedures have been plagued by restenosis due to the formation of endothelial tissue overgrowth at the lesion site. Restenosis is the body's response to the injury of the vessel wall from angioplasty and to the stent as a foreign body. As assessed in clinical trials during the late 1980 and 1990s, using only balloon angioplasty (POBA, plain old balloon angioplasty), up to 50% of patients suffered significant restenosis; but that percentage has dropped to the single to lower two digit range with the introduction of drug-eluting stents. Sirolimus, paclitaxel, and everolimus are the three drugs used in coatings which are currently FDA approved in the United States. As opposed to bare metal, drug eluting stents are covered with a medicine that is slowly dispersed with the goal of suppressing the restenosis reaction. The key to the success of drug coating has been (a) choosing effective agents, (b) developing ways of adequately binding the drugs to the stainless surface of the stent struts (the coating must stay bound despite marked handling and stent deformation stresses), and (c) developing coating controlled release mechanisms that release the drug slowly over about 30 days. One of the newest innovations in coronary stents is the development of a dissolving stent. Abbott Laboratories has used a dissolvable material, polylactic acid, that will completely absorb within 2 years of being implanted.\n\nAlternative approaches \n Angiography (left) and CT (middle and right) of chronic total occlusion lesions at the left anterior descending coronary artery (LAD) and right coronary artery (RCA).\nCT angiography can act as a less invasive alternative to Catheter angiography. Instead of a catheter being inserted into a vein or artery, CT angiography involves only the injection of a CT-visible dye into the arm or hand via an IV line. CT angiography lowers the risk of arterial perforation and catheter site infection. It provides 3D images that can be studied on computer, and also allows measurement of heart ventricle size. Infarct area and arterial calcium can also be observed (however those require a somewhat higher radiation exposure). That said, one advantage retained by Catheter angiography is the ability of the physician to perform procedure such as balloon angioplasty or insertion of a stent to improve blood flow to the artery.[3]\n\nSee also \nAngiography\nInterventional cardiology\nFractional flow reserve\nReferences \nNotes \n\n\n^ Sabatine, edited by Marc S. (2011). Pocket medicine (4th ed.). Philadelphia: Wolters Kluwer Health\/Lippincott Williams & Wilkins. ISBN 1608319059. CS1 maint: Extra text: authors list (link) \n\n^ Hurst, J. Willis; Fuster, Valentin; O'Rourke, Robert A. (2004). Hurst's The Heart. New York: McGraw-Hill, Medical Publishing Division. pp. 489\u201390. ISBN 0-07-142264-1. \n\n^ \"Angiogram vs. CT Catscan Angiogram\". Archived from the original on May 11, 2013. Retrieved July 19, 2013 . \n\n\nGeneral \nConnolly JE. The development of coronary artery surgery: personal recollections. Tex Heart Inst J 2002;29:10-4. PMID 11995842.\nProudfit WL, Shirey EK, Sones FM Jr. Selective cine coronary arteriography. Correlation with clinical findings in 1,000 patients. Circulation 1966;33:901-10. PMID 5942973.\nSones FM, Shirey EK. Cine coronary arteriography. Mod Concepts Cardiovasc Dis 1962;31:735-8. PMID 13915182.\n[1] Coronary CT angiography by Eugene Lin\n[2] Abbott Dissolving Stent May Be \u2018Next Revolution\u2019 by Michelle Fay Cortez\nvteSurgery and other procedures involving the heart (ICD-9-CM V3 35\u201337+89.4+99.6, ICD-10-PCS 02)Surgery and ICHeart valves\r\nand septa\nValve repair\nValvulotomy\nMitral valve repair\nValvuloplasty\naortic\nmitral\nValve replacement\nAortic valve repair\nAortic valve replacement\nRoss procedure\nPercutaneous aortic valve replacement\nMitral valve replacement\nproduction of septal defect in heart \nenlargement of existing septal defect\nAtrial septostomy\nBalloon septostomy<\/dd>\ncreation of septal defect in heart\n\nBlalock\u2013Hanlon procedure<\/dd>\nshunt from heart chamber to blood vessel \natrium to pulmonary artery\nFontan procedure<\/dd>\nleft ventricle to aorta\n\nRastelli procedure<\/dd>\nright ventricle to pulmonary artery\n\nSano shunt<\/dd>\ncompound procedures \nfor transposition of great vessels\nArterial switch operation\nMustard procedure\nSenning procedure<\/dd>\nfor univentricular defect\n\nNorwood procedure\nKawashima procedure<\/dd>\nshunt from blood vessel to blood vessel \nsystemic circulation to pulmonary artery shunt\nBlalock\u2013Taussig shunt<\/dd>\nSVC to the right PA\n\nGlenn procedure<\/dd>\nCardiac vessels\nCHD \nAngioplasty\nBypass\/Coronary artery bypass\nMIDCAB\nOff-pump CAB\nTECAB<\/dd>\nCoronary stent \nBare-metal stent\nDrug-eluting stent\nBentall procedure\nValve-sparing aortic root replacement\nLeCompte maneuver\nOther\nPericardium \nPericardiocentesis\nPericardial window\nPericardiectomy\nMyocardium \nCardiomyoplasty\nDor procedure\nSeptal myectomy\nVentricular reduction\nAlcohol septal ablation\nConduction system \nMaze procedure\nCox maze and minimaze<\/dd>\nCatheter ablation\n\nCryoablation\nRadiofrequency ablation<\/dd>\nPacemaker insertion\nLeft atrial appendage occlusion\nCardiotomy\nHeart transplantation\nDiagnostic\r\ntests and\r\nprocedures\nElectrophysiology \nElectrocardiography\nVectorcardiography<\/dd>\nHolter monitor\nImplantable loop recorder\nCardiac stress test\n\nBruce protocol<\/dd>\nElectrophysiology study\nCardiac imaging \nAngiocardiography\nEchocardiography\nTTE\nTEE<\/dd>\nMyocardial perfusion imaging\nCardiovascular MRI\nVentriculography\n\nRadionuclide ventriculography<\/dd>\nCardiac catheterization\/Coronary catheterization\nCardiac CT\n\nCardiac PET\nsound \nPhonocardiogram\nFunction tests\nImpedance cardiography\nBallistocardiography\nCardiotocography\nPacing\nCardioversion\nTranscutaneous pacing\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Coronary_catheterization\">https:\/\/www.limswiki.org\/index.php\/Coronary_catheterization<\/a>\n\t\t\t\t\tCategory: Medical and surgical techniquesHidden category: Articles 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","7dae9d41420f015e1fc21b33951b5110_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Coronary_catheterization skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Coronary catheterization<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p>A <b>coronary catheterization<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Minimally_invasive\" class=\"mw-redirect\" title=\"Minimally invasive\" rel=\"external_link\" target=\"_blank\">minimally invasive<\/a> procedure to access the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_circulation\" title=\"Coronary circulation\" rel=\"external_link\" target=\"_blank\">coronary circulation<\/a> and blood filled chambers of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart\" title=\"Heart\" rel=\"external_link\" target=\"_blank\">heart<\/a> using a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheter<\/a>. It is performed for both diagnostic and interventional (treatment) purposes.\n<\/p><p>Coronary catheterization is one of the several <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiology_diagnostic_tests_and_procedures\" title=\"Cardiology diagnostic tests and procedures\" rel=\"external_link\" target=\"_blank\">cardiology diagnostic tests and procedures<\/a>. Specifically, coronary catheterization is a visually interpreted test performed to recognize <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular_occlusion\" title=\"Vascular occlusion\" rel=\"external_link\" target=\"_blank\">occlusion<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">stenosis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Restenosis\" title=\"Restenosis\" rel=\"external_link\" target=\"_blank\">restenosis<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Thrombosis\" title=\"Thrombosis\" rel=\"external_link\" target=\"_blank\">thrombosis<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aneurysm\" title=\"Aneurysm\" rel=\"external_link\" target=\"_blank\">aneurysmal<\/a> enlargement of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery\" class=\"mw-redirect\" title=\"Coronary artery\" rel=\"external_link\" target=\"_blank\">coronary artery<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lumen_(anatomy)\" title=\"Lumen (anatomy)\" rel=\"external_link\" target=\"_blank\">lumens<\/a>; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_chamber\" class=\"mw-redirect\" title=\"Heart chamber\" rel=\"external_link\" target=\"_blank\">heart chamber<\/a> size; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_muscle\" class=\"mw-redirect\" title=\"Heart muscle\" rel=\"external_link\" target=\"_blank\">heart muscle<\/a> contraction performance; and some aspects of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_valve\" title=\"Heart valve\" rel=\"external_link\" target=\"_blank\">heart valve<\/a> function. Important internal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart\" title=\"Heart\" rel=\"external_link\" target=\"_blank\">heart<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lung\" title=\"Lung\" rel=\"external_link\" target=\"_blank\">lung<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure\" title=\"Blood pressure\" rel=\"external_link\" target=\"_blank\">blood pressures<\/a>, not measurable from outside the body, can be accurately measured during the test. The relevant problems that the test deals with most commonly occur as a result of advanced <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atherosclerosis\" title=\"Atherosclerosis\" rel=\"external_link\" target=\"_blank\">atherosclerosis<\/a> \u2013 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atheroma\" title=\"Atheroma\" rel=\"external_link\" target=\"_blank\">atheroma<\/a> activity within the wall of the coronary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">arteries<\/a>. Less frequently, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_valve\" title=\"Heart valve\" rel=\"external_link\" target=\"_blank\">valvular<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_muscle\" class=\"mw-redirect\" title=\"Heart muscle\" rel=\"external_link\" target=\"_blank\">heart muscle<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_arrhythmia\" title=\"Heart arrhythmia\" rel=\"external_link\" target=\"_blank\">arrhythmia<\/a> issues are the primary focus of the test.\n<\/p><p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery\" class=\"mw-redirect\" title=\"Coronary artery\" rel=\"external_link\" target=\"_blank\">Coronary artery<\/a> luminal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">narrowing<\/a> reduces the flow reserve for oxygenated blood to the heart, typically producing intermittent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angina_pectoris\" class=\"mw-redirect\" title=\"Angina pectoris\" rel=\"external_link\" target=\"_blank\">angina<\/a>. Very advanced luminal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vascular_occlusion\" title=\"Vascular occlusion\" rel=\"external_link\" target=\"_blank\">occlusion<\/a> usually produces a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myocardial_infarction\" title=\"Myocardial infarction\" rel=\"external_link\" target=\"_blank\">heart attack<\/a>. However, it has been increasingly recognized, since the late 1980s, that coronary catheterization does not allow the recognition of the presence or absence of coronary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atherosclerosis\" title=\"Atherosclerosis\" rel=\"external_link\" target=\"_blank\">atherosclerosis<\/a> itself, only significant luminal changes which have occurred as a result of end stage complications of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atherosclerosis\" title=\"Atherosclerosis\" rel=\"external_link\" target=\"_blank\">atherosclerotic<\/a> process. See <a href=\"https:\/\/en.wikipedia.org\/wiki\/IVUS\" class=\"mw-redirect\" title=\"IVUS\" rel=\"external_link\" target=\"_blank\">IVUS<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atheroma\" title=\"Atheroma\" rel=\"external_link\" target=\"_blank\">atheroma<\/a> for a better understanding of this issue.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/History_of_invasive_and_interventional_cardiology\" title=\"History of invasive and interventional cardiology\" rel=\"external_link\" target=\"_blank\">History of invasive and interventional cardiology<\/a><\/div>\n<p>The technique of angiography itself was first developed in 1927 by the Portuguese physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Egas_Moniz\" class=\"mw-redirect\" title=\"Egas Moniz\" rel=\"external_link\" target=\"_blank\">Egas Moniz<\/a> at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Lisbon\" title=\"University of Lisbon\" rel=\"external_link\" target=\"_blank\">University of Lisbon<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cerebral_angiography\" title=\"Cerebral angiography\" rel=\"external_link\" target=\"_blank\">cerebral angiography<\/a>, the viewing of brain vasculature by X-ray radiation with the aid of a contrast medium introduced by catheter.\n<\/p><p>Heart catheterization was first performed in 1929 when the German physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Werner_Forssmann\" title=\"Werner Forssmann\" rel=\"external_link\" target=\"_blank\">Werner Forssmann<\/a> inserted a plastic tube in his cubital vein and guided it to the right chamber of the heart. He took an x-ray to prove his success and published it on November 5, 1929 with the title \"\u00dcber die Sondierung des rechten Herzens\" (About probing of the right heart).\n<\/p><p>In the early 1940s, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Andr%C3%A9_Cournand\" class=\"mw-redirect\" title=\"Andr\u00e9 Cournand\" rel=\"external_link\" target=\"_blank\">Andr\u00e9 Cournand<\/a>, in collaboration with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dickinson_Richards\" class=\"mw-redirect\" title=\"Dickinson Richards\" rel=\"external_link\" target=\"_blank\">Dickinson Richards<\/a>, performed more systematic measurements of the hemodynamics of the heart. For their work in the discovery of cardiac catheterization and hemodynamic measurements, Cournand, Forssmann, and Richards shared the Nobel Prize in Physiology or Medicine in 1956. The first radial access for angiography can be traced back to 1953, where <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eduardo_Pereira\" title=\"Eduardo Pereira\" rel=\"external_link\" target=\"_blank\">Eduardo Pereira<\/a>, in Lisbon, Portugal, first cannulated the radial artery to perform a coronary angiogram. \n<\/p><p>In 1960 <a href=\"https:\/\/en.wikipedia.org\/wiki\/F._Mason_Sones\" title=\"F. Mason Sones\" rel=\"external_link\" target=\"_blank\">F. Mason Sones<\/a>, a pediatric cardiologist at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cleveland_Clinic\" title=\"Cleveland Clinic\" rel=\"external_link\" target=\"_blank\">Cleveland Clinic<\/a>, accidentally injected radiocontrast in a coronary artery instead of the left ventricle. Although the patient had a reversible cardiac arrest, Sones and Shirey developed the procedure further, and are credited with the discovery (Connolly 2002); they published a series of 1,000 patents in 1966 (Proudfit <i>et al.<\/i>).\n<\/p><p>Since the late 1970s, building on the pioneering work of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Charles_Dotter\" class=\"mw-redirect\" title=\"Charles Dotter\" rel=\"external_link\" target=\"_blank\">Charles Dotter<\/a> in 1964 and especially <a href=\"https:\/\/en.wikipedia.org\/wiki\/Andreas_Gruentzig\" title=\"Andreas Gruentzig\" rel=\"external_link\" target=\"_blank\">Andreas Gruentzig<\/a> starting in 1977, coronary catheterization has been extended to therapeutic uses: (a) the performance of less invasive physical treatment for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angina_pectoris\" class=\"mw-redirect\" title=\"Angina pectoris\" rel=\"external_link\" target=\"_blank\">angina<\/a> and some of the complications of severe <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atherosclerosis\" title=\"Atherosclerosis\" rel=\"external_link\" target=\"_blank\">atherosclerosis<\/a>, (b) treating <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myocardial_infarction\" title=\"Myocardial infarction\" rel=\"external_link\" target=\"_blank\">heart attacks<\/a> before complete damage has occurred and (c) research for better understanding of the pathology of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery_disease\" title=\"Coronary artery disease\" rel=\"external_link\" target=\"_blank\">coronary artery disease<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atherosclerosis\" title=\"Atherosclerosis\" rel=\"external_link\" target=\"_blank\">atherosclerosis<\/a>.\n<\/p><p>In the early 1960s, cardiac catheterization frequently took several hours and involved significant complications for as many as 2\u20133% of patients. With multiple incremental improvements over time, simple coronary catheterization examinations are now commonly done more rapidly and with significantly improved outcomes.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<p>Indications for cardiac catheterization include the following:\n<\/p>\n<ul><li>Heart Attack (includes ST elevation MI, Non-ST Elevation MI, Unstable Angina)<\/li>\n<li>Abnormal Stress Test<\/li>\n<li>New-onset unexplained heart failure<\/li>\n<li>Survival of sudden cardiac death or dangerous cardiac arrhythmia<\/li>\n<li>Persistent chest pain despite optimal medical therapy<\/li>\n<li>Workup of suspected <a href=\"https:\/\/en.wikipedia.org\/wiki\/Prinzmetal%27s_angina\" class=\"mw-redirect\" title=\"Prinzmetal's angina\" rel=\"external_link\" target=\"_blank\">Prinzmetal Angina<\/a> (coronary vasospasm)<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Patient_participation\">Patient participation<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Coronary_Angiography.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/17\/Coronary_Angiography.png\/220px-Coronary_Angiography.png\" width=\"220\" height=\"110\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Coronary_Angiography.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Coronary Angiography.<\/div><\/div><\/div>\n<p>The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient\" title=\"Patient\" rel=\"external_link\" target=\"_blank\">patient<\/a> being examined or treated is usually awake during catheterization, ideally with only <a href=\"https:\/\/en.wikipedia.org\/wiki\/Local_anaesthesia\" class=\"mw-redirect\" title=\"Local anaesthesia\" rel=\"external_link\" target=\"_blank\">local anaesthesia<\/a> such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lidocaine\" title=\"Lidocaine\" rel=\"external_link\" target=\"_blank\">lidocaine<\/a> and minimal general <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sedation\" title=\"Sedation\" rel=\"external_link\" target=\"_blank\">sedation<\/a>, throughout the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_procedure\" class=\"mw-redirect\" title=\"Surgical procedure\" rel=\"external_link\" target=\"_blank\">procedure<\/a>. Performing the procedure with the patient awake is safer as the patient can immediately report any discomfort or problems and thereby facilitate rapid correction of any undesirable events. Medical monitors fail to give a comprehensive view of the patient's immediate well-being; how the patient feels is often a most reliable indicator of procedural safety.\n<\/p><p>Death, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Myocardial_infarction\" title=\"Myocardial infarction\" rel=\"external_link\" target=\"_blank\">myocardial infarction<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stroke\" title=\"Stroke\" rel=\"external_link\" target=\"_blank\">stroke<\/a>, serious <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ventricular_arrhythmia\" class=\"mw-redirect\" title=\"Ventricular arrhythmia\" rel=\"external_link\" target=\"_blank\">ventricular arrhythmia<\/a>, and major vascular complications each occur in less than 1% of patients undergoing catheterization.<sup id=\"rdp-ebb-cite_ref-isbn0-07-142264-1_2-0\" class=\"reference\"><a href=\"#cite_note-isbn0-07-142264-1-2\" rel=\"external_link\">[2]<\/a><\/sup> However, though the imaging portion of the examination is often brief, because of setup and safety issues the patient is often in the lab for 20\u201345 minutes. Any of multiple technical difficulties, while not endangering the patient (indeed added to protect the patient's interests) can significantly increase the examination time.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Equipment\">Equipment<\/span><\/h2>\n<p>Coronary catheterization is performed in a catheterization lab, usually located within a hospital. With current designs, the patient must lie relatively flat on a narrow, minimally padded, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiodensity\" title=\"Radiodensity\" rel=\"external_link\" target=\"_blank\">radiolucent<\/a> (transparent to <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray\" title=\"X-ray\" rel=\"external_link\" target=\"_blank\">X-ray<\/a>) table. The X-ray source and imaging camera equipment are on opposite sides of the patient's chest and freely move, under motorized control, around the patient's chest so images can be taken quickly from multiple angles. More advanced equipment, termed a bi-plane cath lab, uses two sets of X-ray source and imaging cameras, each free to move independently, which allows two sets of images to be taken with each injection of radiocontrast agent. The equipment and installation setup to perform such testing typically represents a capital expenditure of US$2\u20135 million (2004), sometimes more, partially repeated every few years.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Diagnostic_procedures\">Diagnostic procedures<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Angiography_coronary_stenosis_01.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8b\/Angiography_coronary_stenosis_01.jpg\/220px-Angiography_coronary_stenosis_01.jpg\" width=\"220\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Angiography_coronary_stenosis_01.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Coronary angiography of a critical sub-occlusion of the common trunk of the left coronary artery and the circumflex artery. (See arrows)<\/div><\/div><\/div>\n<p>During coronary catheterization (often referred to as a <b>cath<\/b> by physicians), <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure\" title=\"Blood pressure\" rel=\"external_link\" target=\"_blank\">blood pressures<\/a> are recorded and <a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray\" title=\"X-ray\" rel=\"external_link\" target=\"_blank\">X-ray<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Motion_picture\" class=\"mw-redirect\" title=\"Motion picture\" rel=\"external_link\" target=\"_blank\">motion picture<\/a> shadow-grams of the blood inside the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_arteries\" title=\"Coronary arteries\" rel=\"external_link\" target=\"_blank\">coronary arteries<\/a> are recorded. In order to create the X-ray pictures, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physician\" title=\"Physician\" rel=\"external_link\" target=\"_blank\">physician<\/a> guides a small tube-like device called a catheter, typically ~2.0 mm (6-French) in diameter, through the large arteries of the body until the tip is just within the opening of one of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_arteries\" title=\"Coronary arteries\" rel=\"external_link\" target=\"_blank\">coronary arteries<\/a>. By design, the catheter is smaller than the lumen of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">artery<\/a> it is placed in; internal (intra-arterial) blood pressures are monitored through the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catheter\" title=\"Catheter\" rel=\"external_link\" target=\"_blank\">catheter<\/a> to verify that the catheter does not block blood flow.\n<\/p><p>The catheter is itself designed to be <a href=\"https:\/\/en.wikipedia.org\/wiki\/Radiodensity\" title=\"Radiodensity\" rel=\"external_link\" target=\"_blank\">radiodense<\/a> for visibility and it allows a clear, watery, blood compatible radiocontrast agent, commonly called an X-ray dye, to be selectively injected and mixed with the blood flowing within the artery. Typically 3\u20138 cc of the radiocontrast agent is injected for each image to make the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_flow\" class=\"mw-redirect\" title=\"Blood flow\" rel=\"external_link\" target=\"_blank\">blood flow<\/a> visible for about 3\u20135 seconds as the radiocontrast agent is rapidly washed away into the coronary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capillaries\" class=\"mw-redirect\" title=\"Capillaries\" rel=\"external_link\" target=\"_blank\">capillaries<\/a> and then coronary <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vein\" title=\"Vein\" rel=\"external_link\" target=\"_blank\">veins<\/a>. Without the X-ray dye injection, the blood and surrounding heart <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_tissue\" class=\"mw-redirect\" title=\"Biological tissue\" rel=\"external_link\" target=\"_blank\">tissues<\/a> appear, on X-ray, as only a mildly-shape-changing, otherwise uniform water density mass; no details of the blood and internal organ structure are discernible. The radiocontrast within the blood allows visualization of the blood flow within the arteries or heart chambers, depending on where it is injected.\n<\/p><p>If <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atheroma\" title=\"Atheroma\" rel=\"external_link\" target=\"_blank\">atheroma<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clot\" class=\"mw-redirect\" title=\"Clot\" rel=\"external_link\" target=\"_blank\">clots<\/a>, are protruding into the lumen, producing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">narrowing<\/a>, the narrowing may be seen instead as increased haziness within the X-ray shadow images of the blood\/dye column within that portion of the artery; this is as compared to adjacent, presumed healthier, less <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">stenotic<\/a> areas. See the single frame illustration of a coronary angiogram image on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angioplasty\" title=\"Angioplasty\" rel=\"external_link\" target=\"_blank\">angioplasty<\/a> page.\n<\/p><p>For guidance regarding catheter positions during the examination, the physician mostly relies on detailed knowledge of internal anatomy, guide wire and catheter behavior and intermittently, briefly uses <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">fluoroscopy<\/a> and a low X-ray dose to visualize when needed. This is done without saving recordings of these brief looks. When the physician is ready to record , which are saved and can be more carefully scrutinized later, he activates the equipment to apply a significantly higher X-ray dose, termed <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cine\" class=\"mw-redirect\" title=\"Cine\" rel=\"external_link\" target=\"_blank\">cine<\/a>, in order to create better quality motion picture images, having sharper radiodensity contrast, typically at 30 frames per second. The physician controls both the contrast injection, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">fluoroscopy<\/a> and cine application timing so as to minimize the total amount of radiocontrast injected and times the X-Ray to the injection so as to minimize the total amount of X-ray used. Doses of radiocontrast agents and X-ray exposure times are routinely recorded in an effort to maximize safety.\n<\/p><p>Though not the focus of the test, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calcification\" title=\"Calcification\" rel=\"external_link\" target=\"_blank\">calcification<\/a> within the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">artery<\/a> walls, located in the outer edges of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Atheroma\" title=\"Atheroma\" rel=\"external_link\" target=\"_blank\">atheroma<\/a> within the artery walls, is sometimes recognizable on fluoroscopy (without contrast injection) as radiodense halo rings partially encircling, and separated from the blood filled lumen by the interceding radiolucent atheroma tissue and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endothelium\" title=\"Endothelium\" rel=\"external_link\" target=\"_blank\">endothelial<\/a> lining. Calcification, even though usually present, is usually only visible when quite advanced and calcified sections of the artery wall happen to be viewed on end <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tangent\" title=\"Tangent\" rel=\"external_link\" target=\"_blank\">tangentially<\/a> through multiple rings of calcification, so as to create enough radiodensity to be visible on fluoroscopy.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Therapeutic_procedures\">Therapeutic procedures<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Percutaneous_coronary_intervention\" title=\"Percutaneous coronary intervention\" rel=\"external_link\" target=\"_blank\">Percutaneous coronary intervention<\/a><\/div>\n<p>By changing the diagnostic catheter to a guiding catheter, physicians can also pass a variety of instruments through the catheter and into the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">artery<\/a> to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lesion\" title=\"Lesion\" rel=\"external_link\" target=\"_blank\">lesion<\/a> site. The most commonly used are 0.014-inch-diameter (0.36 mm) guide wires and the balloon dilation catheters.\n<\/p><p>By injecting radiocontrast agent through a tiny passage extending down the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Balloon_catheter\" title=\"Balloon catheter\" rel=\"external_link\" target=\"_blank\">balloon catheter<\/a> and into the balloon, the balloon is progressively expanded. The hydraulic pressures are chosen and applied by the physician, according to how the balloon within the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stenosis\" title=\"Stenosis\" rel=\"external_link\" target=\"_blank\">stenosis<\/a> (abnormal narrowing in a blood vessel) responds. The radiocontrast filled balloon is watched under <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fluoroscopy\" title=\"Fluoroscopy\" rel=\"external_link\" target=\"_blank\">fluoroscopy<\/a> (it typically assumes a \"dog bone\" shape imposed on the outside of the balloon by the stenosis as the balloon is expanded), as it opens. As much <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hydraulic\" class=\"mw-redirect\" title=\"Hydraulic\" rel=\"external_link\" target=\"_blank\">hydraulic<\/a> brute force is applied as judged needed and visualized to be effective to make the stenosis of the artery lumen visibly enlarge.\n<\/p><p>Typical normal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_artery\" class=\"mw-redirect\" title=\"Coronary artery\" rel=\"external_link\" target=\"_blank\">coronary artery<\/a> pressures are in the <200 mmHg range (27 kPa). The hydraulic pressures applied within the balloon may extend to as high as 19000 mmHg (2,500 kPa). Prevention of over-enlargement is achieved by choosing balloons manufactured out of high tensile strength clear plastic membranes. The balloon is initially folded around the catheter, near the tip, to create a small cross-sectional profile to facilitate passage though luminal stenotic areas, and is designed to inflate to a specific pre-designed diameter. If over inflated, the balloon material simply tears and allows the inflating radiocontrast agent to simply escape into the blood.\n<\/p><p>Additionally, several other devices can be advanced into the artery via a guiding catheter. These include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laser\" title=\"Laser\" rel=\"external_link\" target=\"_blank\">laser<\/a> catheters, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stent<\/a> catheters, <a href=\"https:\/\/en.wikipedia.org\/wiki\/IVUS\" class=\"mw-redirect\" title=\"IVUS\" rel=\"external_link\" target=\"_blank\">IVUS<\/a> catheters, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Doppler_echocardiography\" title=\"Doppler echocardiography\" rel=\"external_link\" target=\"_blank\">Doppler<\/a> catheter, pressure or temperature measurement catheter and various <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clot\" class=\"mw-redirect\" title=\"Clot\" rel=\"external_link\" target=\"_blank\">clot<\/a> and grinding or removal devices. Most of these devices have turned out to be niche devices, only useful in a small percentage of situations or for research.\n<\/p><p>Stents, which are specially manufactured expandable stainless steel mesh tubes, mounted on a balloon catheter, are the most commonly used device beyond the balloon catheter. When the stent\/balloon device is positioned within the stenosis, the balloon is inflated which, in turn, expands the stent and the artery. The balloon is removed and the stent remains in place, supporting the inner artery walls in the more open, dilated position. Current stents generally cost around $1,000 to 3,000 each (US 2004 dollars), the drug coated ones being the more expensive.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Advances_in_catheter_based_physical_treatments\">Advances in catheter based physical treatments<\/span><\/h2>\n<p>Interventional procedures have been plagued by restenosis due to the formation of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endothelium\" title=\"Endothelium\" rel=\"external_link\" target=\"_blank\">endothelial<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biological_tissue\" class=\"mw-redirect\" title=\"Biological tissue\" rel=\"external_link\" target=\"_blank\">tissue<\/a> overgrowth at the lesion site. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Restenosis\" title=\"Restenosis\" rel=\"external_link\" target=\"_blank\">Restenosis<\/a> is the body's response to the injury of the vessel wall from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angioplasty\" title=\"Angioplasty\" rel=\"external_link\" target=\"_blank\">angioplasty<\/a> and to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stent<\/a> as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign_body\" title=\"Foreign body\" rel=\"external_link\" target=\"_blank\">foreign body<\/a>. As assessed in clinical trials during the late 1980 and 1990s, using only balloon angioplasty (POBA, plain old balloon angioplasty), up to 50% of patients suffered significant restenosis; but that percentage has dropped to the single to lower two digit range with the introduction of drug-eluting stents. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sirolimus\" title=\"Sirolimus\" rel=\"external_link\" target=\"_blank\">Sirolimus<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paclitaxel\" title=\"Paclitaxel\" rel=\"external_link\" target=\"_blank\">paclitaxel<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Everolimus\" title=\"Everolimus\" rel=\"external_link\" target=\"_blank\">everolimus<\/a> are the three drugs used in coatings which are currently FDA approved in the United States. As opposed to bare metal, drug eluting stents are covered with a medicine that is slowly dispersed with the goal of suppressing the restenosis reaction. The key to the success of drug coating has been (a) choosing effective agents, (b) developing ways of adequately binding the drugs to the stainless surface of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stent<\/a> struts (the coating must stay bound despite marked handling and stent deformation stresses), and (c) developing coating controlled release mechanisms that release the drug slowly over about 30 days. One of the newest innovations in coronary stents is the development of a dissolving stent. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abbott_Laboratories\" title=\"Abbott Laboratories\" rel=\"external_link\" target=\"_blank\">Abbott Laboratories<\/a> has used a dissolvable material, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polylactic_acid\" title=\"Polylactic acid\" rel=\"external_link\" target=\"_blank\">polylactic acid<\/a>, that will completely absorb within 2 years of being implanted.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Alternative_approaches\">Alternative approaches<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Coronary_revascularization.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/40\/Coronary_revascularization.png\/220px-Coronary_revascularization.png\" width=\"220\" height=\"185\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Coronary_revascularization.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Angiography (left) and CT (middle and right) of chronic total occlusion lesions at the left anterior descending coronary artery (LAD) and right coronary artery (RCA).<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/X-ray_computed_tomography\" class=\"mw-redirect\" title=\"X-ray computed tomography\" rel=\"external_link\" target=\"_blank\">CT angiography<\/a> can act as a less invasive alternative to Catheter angiography. Instead of a catheter being inserted into a vein or artery, CT angiography involves only the injection of a CT-visible dye into the arm or hand via an IV line. CT angiography lowers the risk of arterial perforation and catheter site infection. It provides 3D images that can be studied on computer, and also allows measurement of heart ventricle size. Infarct area and arterial calcium can also be observed (however those require a somewhat higher radiation exposure). That said, one advantage retained by Catheter angiography is the ability of the physician to perform procedure such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Angioplasty\" title=\"Angioplasty\" rel=\"external_link\" target=\"_blank\">balloon angioplasty<\/a> or insertion of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stent\" title=\"Stent\" rel=\"external_link\" target=\"_blank\">stent<\/a> to improve blood flow to the artery.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Angiography\" title=\"Angiography\" rel=\"external_link\" target=\"_blank\">Angiography<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Interventional_cardiology\" title=\"Interventional cardiology\" rel=\"external_link\" target=\"_blank\">Interventional cardiology<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Fractional_flow_reserve\" title=\"Fractional flow reserve\" rel=\"external_link\" target=\"_blank\">Fractional flow reserve<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h3>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Sabatine, edited by Marc S. (2011). <i>Pocket medicine<\/i> (4th ed.). Philadelphia: Wolters Kluwer Health\/Lippincott Williams & Wilkins. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 1608319059.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Pocket+medicine&rft.place=Philadelphia&rft.edition=4th&rft.pub=Wolters+Kluwer+Health%2FLippincott+Williams+%26+Wilkins&rft.date=2011&rft.isbn=1608319059&rft.aulast=Sabatine&rft.aufirst=edited+by+Marc+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACoronary+catheterization\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Extra text: authors list (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Extra_text:_authors_list\" title=\"Category:CS1 maint: Extra text: authors list\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><\/span>\n<\/li>\n<li id=\"cite_note-isbn0-07-142264-1-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-isbn0-07-142264-1_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Hurst, J. Willis; Fuster, Valentin; O'Rourke, Robert A. (2004). <a rel=\"external_link\" class=\"external text\" href=\"#PRA2-PA489\"><i>Hurst's The Heart<\/i><\/a>. New York: McGraw-Hill, Medical Publishing Division. pp. 489\u201390. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-07-142264-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Hurst%27s+The+Heart&rft.place=New+York&rft.pages=489-90&rft.pub=McGraw-Hill%2C+Medical+Publishing+Division&rft.date=2004&rft.isbn=0-07-142264-1&rft.au=Hurst%2C+J.+Willis&rft.au=Fuster%2C+Valentin&rft.au=O%27Rourke%2C+Robert+A.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D5Yl1LNe69lwC%26pg%3DRA2-PA481%23PRA2-PA489&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACoronary+catheterization\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20130511054812\/http:\/\/www.ct-angiogram.com\/Angiogram_vs._CT_Catscan_Angiogram_2273.htm\" target=\"_blank\">\"Angiogram vs. CT Catscan Angiogram\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ct-angiogram.com\/Angiogram_vs._CT_Catscan_Angiogram_2273.htm\" target=\"_blank\">the original<\/a> on May 11, 2013<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">July 19,<\/span> 2013<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Angiogram+vs.+CT+Catscan+Angiogram&rft_id=http%3A%2F%2Fwww.ct-angiogram.com%2FAngiogram_vs._CT_Catscan_Angiogram_2273.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACoronary+catheterization\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"General\">General<\/span><\/h3>\n<ul><li>Connolly JE. The development of coronary artery surgery: personal recollections. <i>Tex Heart Inst J<\/i> 2002;29:10-4. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11995842\" target=\"_blank\">11995842<\/a>.<\/li>\n<li>Proudfit WL, Shirey EK, Sones FM Jr. Selective cine coronary arteriography. Correlation with clinical findings in 1,000 patients. <i>Circulation<\/i> 1966;33:901-10. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/5942973\" target=\"_blank\">5942973<\/a>.<\/li>\n<li>Sones FM, Shirey EK. Cine coronary arteriography. <i>Mod Concepts Cardiovasc Dis<\/i> 1962;31:735-8. <link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/13915182\" target=\"_blank\">13915182<\/a>.<\/li>\n<li><a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/emedicine.medscape.com\/article\/1603072-overview\" target=\"_blank\">[1]<\/a> Coronary CT angiography by Eugene Lin<\/li>\n<li><a rel=\"external_link\" class=\"external autonumber\" href=\"https:\/\/web.archive.org\/web\/20101018180232\/http:\/\/www.businessweek.com\/news\/2010-09-09\/abbott-dissolving-stent-may-be-next-revolution-.html\" target=\"_blank\">[2]<\/a> Abbott Dissolving Stent May Be \u2018Next Revolution\u2019 by Michelle Fay Cortez<\/li><\/ul>\n\n<p><!-- \nNewPP limit report\nParsed by mw1325\nCached time: 20181205151601\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.300 seconds\nReal time usage: 0.397 seconds\nPreprocessor visited node count: 984\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 42969\/2097152 bytes\nTemplate argument size: 1183\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 14805\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.125\/10.000 seconds\nLua memory usage: 4.2 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 302.909 1 -total\n<\/p>\n<pre>31.57% 95.634 1 Template:Infobox_medical_intervention\n30.45% 92.242 1 Template:Reflist\n29.12% 88.204 1 Template:Infobox\n23.10% 69.968 2 Template:Cite_book\n14.62% 44.295 1 Template:Convert\n10.92% 33.089 2 Template:Navbox\n 8.93% 27.053 1 Template:Cardiac_procedures\n 6.79% 20.553 3 Template:PMID\n 6.15% 18.636 2 Template:Main\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:582832-1!canonical and timestamp 20181205151600 and revision id 859336064\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Coronary_catheterization\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214658\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.030 seconds\nReal time usage: 0.173 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 165.348 1 - wikipedia:Coronary_catheterization\n100.00% 165.348 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8564-0!*!*!*!*!*!* and timestamp 20181217214658 and revision id 24992\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Coronary_catheterization\">https:\/\/www.limswiki.org\/index.php\/Coronary_catheterization<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","7dae9d41420f015e1fc21b33951b5110_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/81\/Ha1.jpg\/560px-Ha1.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/17\/Coronary_Angiography.png\/440px-Coronary_Angiography.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/8b\/Angiography_coronary_stenosis_01.jpg\/440px-Angiography_coronary_stenosis_01.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/40\/Coronary_revascularization.png\/440px-Coronary_revascularization.png"],"7dae9d41420f015e1fc21b33951b5110_timestamp":1545083218,"a861e2413242a1a61c199e0a714946fe_type":"article","a861e2413242a1a61c199e0a714946fe_title":"Corneal pachymetry","a861e2413242a1a61c199e0a714946fe_url":"https:\/\/www.limswiki.org\/index.php\/Corneal_pachymetry","a861e2413242a1a61c199e0a714946fe_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCorneal pachymetry\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (February 2015) (Learn how and when to remove this template message)\nCorneal pachymetryMedical diagnosticsA typical ultrasound pachymeter\nCorneal pachymetry is the process of measuring the thickness of the cornea. A pachymeter is a medical device used to measure the thickness of the eye's cornea. It is used to perform corneal pachymetry prior to refractive surgery, for Keratoconus screening, LRI surgery [1] and is useful in screening for patients suspected of developing glaucoma among other uses.\n\nContents \n\n1 Process \n2 Pachymeters \n3 Indications \n4 Technology \n5 References \n\n\nProcess \nIt can be done using either ultrasonic or optical methods . The contact methods, such as ultrasound and optical such as confocal microscopy (CONFOSCAN), or noncontact methods such as optical biometry with a single Scheimpflug camera (such as SIRIUS or PENTACAM), or a Dual Scheimpflug camera (such as GALILEI), or Optical Coherence Tomography (OCT, such as Visante) and online Optical Coherence Pachymetry (OCP, such as ORBSCAN). Corneal Pachymetry is essential prior to a refractive surgery procedure for ensuring sufficient corneal thickness to prevent abnormal bulging of the cornea, a side effect known as ectasia.\n\nPachymeters \nThe instrument used for this purpose is known as a pachymeter. Conventional pachymeters are devices that display the thickness of the cornea, usually in micrometres, when the ultrasonic transducer touches the cornea. Newer generations of ultrasonic pachymeters work by way of Corneal Waveform (CWF). Using this technology the user can capture an ultra-high definition echogram of the cornea, somewhat like a corneal A-scan. Pachymetry using the corneal waveform process allows the user to more accurately measure the corneal thickness, verify the reliability of the measurements that were obtained, superimpose corneal waveforms to monitor changes in a patient's cornea over time, and measure structures within the cornea such as micro bubbles created during femto-second laser flap cuts.[2]\n\nIndications \nCorneal pachymetry is essential for other corneal surgeries such as Limbal Relaxing Incisions. LRI[3] is used to reduce corneal astigmatism by placing a pair of incisions of a particular depth and arc length at a steep axis of corneal astigmatism. By using the corneal pachymetry the surgeon will reduce the chances of perforation of the eye and improves surgical outcome. Newer generations of pachymeters will help surgeons by providing graphical surgical plans to eliminate astigmatism.\nCorneal pachymetry is also considered an important test in the early detection of glaucoma. In 2002, the five-year report of the Ocular Hypertension Study (OHTS) was released. The study reported that corneal thickness as measured by corneal pachymetry was an accurate predictor of glaucoma development when combined with standard measurements of intraocular pressure. As a result of this study and others that followed, corneal pachymetry is now widely used by both glaucoma researchers and glaucoma specialists to better diagnose and detect early cases. Newer generation pachymeters have the ability to adjust the intraocular pressure that is measured according to the corneal thickness.\n\nTechnology \nModern devices use ultrasound technology, while earlier models were based on optical principles. The ultrasonic Pachymeters traditionally have been devices that provide the thickness of the human cornea in the form of a number in micrometres that is displayed to the user. The newer generation of ultrasonic pachymeters work by way of Corneal Waveform (CWF). Using this technology the user can capture an ultra high definition echogram of cornea, think of it as a corneal A-scan. Pachymetry using the corneal waveform allows the user to more accurately measure the corneal thickness, have the ability to check the reliability of the measurements that were obtained, have the ability to superimpose corneal waveform to monitor the change of patients cornea over time, and ability to measure structures within the cornea such as micro bubbles created in the cornea during femto-second laser flap cut.[2]\n\nReferences \n\n\n^ [1][dead link ] \n\n^ a b Eisner, R; Israel, R (November 1, 2006). \"Corneal waveform measurements has advantages in pachymetry\". Ocular Surgery News. 24 (21). \n\n^ \"Limbal Relaxing Incisions Made Simple | OphthalmologyWeb: The Ultimate Online Resource for Ophthalmologists\". Ophthalmologyweb.com. 2008-08-27. Retrieved 2015-02-22 . \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Corneal_pachymetry\">https:\/\/www.limswiki.org\/index.php\/Corneal_pachymetry<\/a>\n\t\t\t\t\tCategories: Medical and surgical techniquesMedical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:33.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 643 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","a861e2413242a1a61c199e0a714946fe_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Corneal_pachymetry skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Corneal pachymetry<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n\n<p><b>Corneal pachymetry<\/b> is the process of measuring the thickness of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornea\" title=\"Cornea\" rel=\"external_link\" target=\"_blank\">cornea<\/a>. A <b>pachymeter<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">medical device<\/a> used to measure the thickness of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_eye\" title=\"Human eye\" rel=\"external_link\" target=\"_blank\">eye<\/a>'s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornea\" title=\"Cornea\" rel=\"external_link\" target=\"_blank\">cornea<\/a>. It is used to perform corneal pachymetry prior to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refractive_surgery\" title=\"Refractive surgery\" rel=\"external_link\" target=\"_blank\">refractive surgery<\/a>, for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Keratoconus\" title=\"Keratoconus\" rel=\"external_link\" target=\"_blank\">Keratoconus<\/a> screening, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Limbal_relaxing_incisions\" title=\"Limbal relaxing incisions\" rel=\"external_link\" target=\"_blank\">LRI surgery<\/a> <sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> and is useful in screening for patients suspected of developing <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glaucoma\" title=\"Glaucoma\" rel=\"external_link\" target=\"_blank\">glaucoma<\/a> among other uses.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Process\">Process<\/span><\/h2>\n<p>It can be done using either ultrasonic or optical methods . The contact methods, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ultrasound\" title=\"Ultrasound\" rel=\"external_link\" target=\"_blank\">ultrasound<\/a> and optical such as confocal microscopy (CONFOSCAN), or noncontact methods such as optical biometry with a single Scheimpflug camera (such as SIRIUS or PENTACAM), or a Dual Scheimpflug camera (such as GALILEI), or Optical Coherence Tomography (OCT, such as Visante) and online Optical Coherence Pachymetry (OCP, such as ORBSCAN). Corneal Pachymetry is essential prior to a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Refractive_surgery\" title=\"Refractive surgery\" rel=\"external_link\" target=\"_blank\">refractive surgery<\/a> procedure for ensuring sufficient corneal thickness to prevent abnormal bulging of the cornea, a side effect known as ectasia.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Pachymeters\">Pachymeters<\/span><\/h2>\n<p>The instrument used for this purpose is known as a <i>pachymeter<\/i>. Conventional pachymeters are devices that display the thickness of the cornea, usually in micrometres, when the ultrasonic transducer touches the cornea. Newer generations of ultrasonic pachymeters work by way of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corneal_Waveform_(CWF)\" class=\"mw-redirect\" title=\"Corneal Waveform (CWF)\" rel=\"external_link\" target=\"_blank\">Corneal Waveform (CWF)<\/a>. Using this technology the user can capture an ultra-high definition echogram of the cornea, somewhat like a corneal A-scan. Pachymetry using the corneal waveform process allows the user to more accurately measure the corneal thickness, verify the reliability of the measurements that were obtained, superimpose corneal waveforms to monitor changes in a patient's cornea over time, and measure structures within the cornea such as micro bubbles created during femto-second laser flap cuts.<sup id=\"rdp-ebb-cite_ref-Eisner2006_2-0\" class=\"reference\"><a href=\"#cite_note-Eisner2006-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Indications\">Indications<\/span><\/h2>\n<p>Corneal pachymetry is essential for other corneal surgeries such as Limbal Relaxing Incisions. LRI<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> is used to reduce corneal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Astigmatism\" title=\"Astigmatism\" rel=\"external_link\" target=\"_blank\">astigmatism<\/a> by placing a pair of incisions of a particular depth and arc length at a steep axis of corneal astigmatism. By using the corneal pachymetry the surgeon will reduce the chances of perforation of the eye and improves surgical outcome. Newer generations of pachymeters will help surgeons by providing graphical surgical plans to eliminate astigmatism.\n<\/p><p>Corneal pachymetry is also considered an important test in the early detection of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glaucoma\" title=\"Glaucoma\" rel=\"external_link\" target=\"_blank\">glaucoma<\/a>. In 2002, the five-year report of the Ocular Hypertension Study (OHTS) was released. The study reported that corneal thickness as measured by corneal pachymetry was an accurate predictor of glaucoma development when combined with standard measurements of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Intraocular_pressure\" title=\"Intraocular pressure\" rel=\"external_link\" target=\"_blank\">intraocular pressure<\/a>. As a result of this study and others that followed, corneal pachymetry is now widely used by both glaucoma researchers and glaucoma specialists to better diagnose and detect early cases. Newer generation pachymeters have the ability to adjust the intraocular pressure that is measured according to the corneal thickness.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Technology\">Technology<\/span><\/h2>\n<p>Modern devices use ultrasound technology, while earlier models were based on optical principles. The ultrasonic Pachymeters traditionally have been devices that provide the thickness of the human cornea in the form of a number in micrometres that is displayed to the user. The newer generation of ultrasonic pachymeters work by way of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corneal_Waveform_(CWF)\" class=\"mw-redirect\" title=\"Corneal Waveform (CWF)\" rel=\"external_link\" target=\"_blank\">Corneal Waveform (CWF)<\/a>. Using this technology the user can capture an ultra high definition echogram of cornea, think of it as a corneal A-scan. Pachymetry using the corneal waveform allows the user to more accurately measure the corneal thickness, have the ability to check the reliability of the measurements that were obtained, have the ability to superimpose corneal waveform to monitor the change of patients cornea over time, and ability to measure structures within the cornea such as micro bubbles created in the cornea during femto-second laser flap cut.<sup id=\"rdp-ebb-cite_ref-Eisner2006_2-1\" class=\"reference\"><a href=\"#cite_note-Eisner2006-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/www.micromedinc.com\/docs\/LRI.pps?phpMyAdmin=Fcl1OjyGwOwdRVEgAYHUz%2CRRli1\" target=\"_blank\">[1]<\/a><sup class=\"noprint Inline-Template\"><span style=\"white-space: nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Link_rot\" title=\"Wikipedia:Link rot\" rel=\"external_link\" target=\"_blank\"><span title=\" Dead link since June 2016\">dead link<\/span><\/a><\/i>]<\/span><\/sup><\/span>\n<\/li>\n<li id=\"cite_note-Eisner2006-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Eisner2006_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Eisner2006_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Eisner, R; Israel, R (November 1, 2006). \"Corneal waveform measurements has advantages in pachymetry\". <i>Ocular Surgery News<\/i>. <b>24<\/b> (21).<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ocular+Surgery+News&rft.atitle=Corneal+waveform+measurements+has+advantages+in+pachymetry&rft.volume=24&rft.issue=21&rft.date=2006-11-01&rft.aulast=Eisner&rft.aufirst=R&rft.au=Israel%2C+R&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACorneal+pachymetry\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ophthalmologyweb.com\/Tech-Spotlights\/26497-Limbal-Relaxing-Incisions-Made-Simple\/\" target=\"_blank\">\"Limbal Relaxing Incisions Made Simple | OphthalmologyWeb: The Ultimate Online Resource for Ophthalmologists\"<\/a>. Ophthalmologyweb.com. 2008-08-27<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2015-02-22<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Limbal+Relaxing+Incisions+Made+Simple+%26%23124%3B+OphthalmologyWeb%3A+The+Ultimate+Online+Resource+for+Ophthalmologists&rft.pub=Ophthalmologyweb.com&rft.date=2008-08-27&rft_id=http%3A%2F%2Fwww.ophthalmologyweb.com%2FTech-Spotlights%2F26497-Limbal-Relaxing-Incisions-Made-Simple%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACorneal+pachymetry\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1275\nCached time: 20181130000029\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.200 seconds\nReal time usage: 0.266 seconds\nPreprocessor visited node count: 540\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 10458\/2097152 bytes\nTemplate argument size: 713\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 5935\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.108\/10.000 seconds\nLua memory usage: 2.38 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 239.285 1 -total\n<\/p>\n<pre>54.42% 130.229 1 Template:Reflist\n33.23% 79.508 1 Template:Cite_news\n29.75% 71.177 1 Template:Refimprove\n18.74% 44.837 1 Template:Ambox\n14.01% 33.514 1 Template:Infobox_diagnostic\n12.16% 29.095 1 Template:Infobox\n 8.38% 20.059 1 Template:Dead_link\n 6.65% 15.908 1 Template:Fix\n 4.46% 10.676 2 Template:Category_handler\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:17212274-1!canonical and timestamp 20181130000029 and revision id 865950838\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Corneal_pachymetry\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214657\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.146 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 140.973 1 - wikipedia:Corneal_pachymetry\n100.00% 140.973 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8563-0!*!*!*!*!*!* and timestamp 20181217214657 and revision id 24991\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Corneal_pachymetry\">https:\/\/www.limswiki.org\/index.php\/Corneal_pachymetry<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","a861e2413242a1a61c199e0a714946fe_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5f\/Pachymeter_%28by_itucker_at_Flickr%29.jpg\/580px-Pachymeter_%28by_itucker_at_Flickr%29.jpg"],"a861e2413242a1a61c199e0a714946fe_timestamp":1545083217,"5e264bde9598d2c256a0d8b5cebe251a_type":"article","5e264bde9598d2c256a0d8b5cebe251a_title":"Augmented reality assisted surgery","5e264bde9598d2c256a0d8b5cebe251a_url":"https:\/\/www.limswiki.org\/index.php\/Augmented_reality_assisted_surgery","5e264bde9598d2c256a0d8b5cebe251a_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tAugmented reality assisted surgery\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tAugmented reality-assisted surgery (ARAS) is a surgical tool utilizing technology that superimposes a computer-generated image on a surgeon\u2019s view of the operative field, thus providing a composite view for the surgeon of the patient with a computer generated overlay enhancing the operative experience. It can be used for training, preparation for an operation, or performance of an operation. ARAS can be performed using a wide array of technology, including an optical head-mounted display (OHMD)\u2014such as the Google Glass XE 22.1 or Vuzix STAR 1200 XL[1]\u2014and a digital overlay from robotic and laparoscopic surgery feeds.[2] The technique has been primarily been tested in the urological and cardiovascular domains.[1][3][4]\n\nSpecialized uses \nA subset of ARAS called augmented reality-assisted urologic surgery (ARAUS) specifically aids with urological surgery. This intraoperative training tool was first described and utilized by Tariq S. Hakky, Ryan M. Dickey, and Larry I. Lipshultz within the Scott Department of Urology, Baylor College of Medicine, and Daniel R. Martinez, Rafael E. Carrion, and Philippe E. Spiess within the Sexual Medicine Program in the Department of Urology, at the University of South Florida.[1] It was initially used to teach medical residents how to place a penile prosthesis from start to finish via an application downloaded onto the OHMD. Intraoperatively, an optical display camera output feed combined with software allowing for the detection of points of interest enabled faculty to interact with residents during the placement of the penile prosthesis. Both faculty and residents demonstrated a high degree of satisfaction of the ARAUS experience, and it was shown to be an effective tool in training urological surgical technique. Advantages of ARAUS include real-time feedback of residents during surgery and superior visibility and interaction between faculty and residents.[1][3]\nARAS has also been applied to the cardiovascular realm. Terry Peters of the University of Western Ontario in London, Canada has teamed up with other researchers at the Robarts Research Institute to implement ARAS towards the goal of improving repairs to the heart's mitral valve and replacement of the aortic valve.[4] In an interview for the Medical Augmented Reality Blog, Peters stated that his research team could not only use ARAS to \"[improve] the speed and safety of the cardiac valve repair procedure\"; they also conducted \"the evaluation of an AR environment to plan brain-tumor removal, and the development of an ARF-enhanced system for ultrasound-guided spinal injections.\"[5]\n\nReferences \n\n\n^ a b c d Hakky, Tariq; Martinez, Daniel; Lipshultz, Larry; Spiess, Philippe; Carrion, Rafael (2015). \"Augmented Reality Assisted Urologic Surgery (ARAUS): A surgical training tool\". The Journal of Urology. 193 (4): e271. doi:10.1016\/j.juro.2015.02.1254. \n\n^ Scopis Surgical Navigation (23 November 2012). Scopis Augmented Reality: Path guidance to craniopharyngioma. YouTube. Retrieved 16 February 2016 . \n\n^ a b Dickey, R.M.; Srikishen, N.; Lipshultz, L.I.; et al. \"Augmented reality assisted surgery: A urologic training tool\". Asian Journal of Andrology. 0 (0): 0. doi:10.4103\/1008-682X.166436. PMID 26620455. \n\n^ a b Peters, Terry (21 May 2015). \"Augmented-Reality Assisted Surgery on the Beating Heart\". IEEE Toronto. Retrieved 16 February 2016 . \n\n^ Bichlmeier, Christoph (8 November 2014). \"Interview with Terry Peters \u2013 Bringing Research to Clinical Practice\". Medical Augmented Reality Blog. Retrieved 16 February 2016 . \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Augmented_reality_assisted_surgery\">https:\/\/www.limswiki.org\/index.php\/Augmented_reality_assisted_surgery<\/a>\n\t\t\t\t\tCategories: Medical and surgical techniquesMedical devicesHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 1 March 2016, at 20:06.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 506 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","5e264bde9598d2c256a0d8b5cebe251a_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Augmented_reality_assisted_surgery skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Augmented reality assisted surgery<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Augmented reality-assisted surgery<\/b> (<b>ARAS<\/b>) is a surgical tool utilizing technology that superimposes a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computer-generated_image\" class=\"mw-redirect\" title=\"Computer-generated image\" rel=\"external_link\" target=\"_blank\">computer-generated image<\/a> on a surgeon\u2019s view of the operative field, thus providing a composite view for the surgeon of the patient with a computer generated overlay enhancing the operative experience. It can be used for training, preparation for an operation, or performance of an operation. ARAS can be performed using a wide array of technology, including an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optical_head-mounted_display\" title=\"Optical head-mounted display\" rel=\"external_link\" target=\"_blank\">optical head-mounted display<\/a> (OHMD)\u2014such as the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Google_Glass\" title=\"Google Glass\" rel=\"external_link\" target=\"_blank\">Google Glass<\/a> XE 22.1 or Vuzix STAR 1200 XL<sup id=\"rdp-ebb-cite_ref-HakkyAug15_1-0\" class=\"reference\"><a href=\"#cite_note-HakkyAug15-1\" rel=\"external_link\">[1]<\/a><\/sup>\u2014and a digital overlay from robotic and laparoscopic surgery feeds.<sup id=\"rdp-ebb-cite_ref-Scopis12_2-0\" class=\"reference\"><a href=\"#cite_note-Scopis12-2\" rel=\"external_link\">[2]<\/a><\/sup> The technique has been primarily been tested in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Urology\" title=\"Urology\" rel=\"external_link\" target=\"_blank\">urological<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiovascular_system\" class=\"mw-redirect\" title=\"Cardiovascular system\" rel=\"external_link\" target=\"_blank\">cardiovascular<\/a> domains.<sup id=\"rdp-ebb-cite_ref-HakkyAug15_1-1\" class=\"reference\"><a href=\"#cite_note-HakkyAug15-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-DickeyAug15_3-0\" class=\"reference\"><a href=\"#cite_note-DickeyAug15-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-PetersAug15_4-0\" class=\"reference\"><a href=\"#cite_note-PetersAug15-4\" rel=\"external_link\">[4]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Specialized_uses\">Specialized uses<\/span><\/h2>\n<p>A subset of ARAS called augmented reality-assisted urologic surgery (ARAUS) specifically aids with urological <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a>. This intraoperative training tool was first described and utilized by Tariq S. Hakky, Ryan M. Dickey, and Larry I. Lipshultz within the Scott Department of Urology, Baylor College of Medicine, and Daniel R. Martinez, Rafael E. Carrion, and Philippe E. Spiess within the Sexual Medicine Program in the Department of Urology, at the University of South Florida.<sup id=\"rdp-ebb-cite_ref-HakkyAug15_1-2\" class=\"reference\"><a href=\"#cite_note-HakkyAug15-1\" rel=\"external_link\">[1]<\/a><\/sup> It was initially used to teach medical residents how to place a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Penile_prosthesis\" title=\"Penile prosthesis\" rel=\"external_link\" target=\"_blank\">penile prosthesis<\/a> from start to finish via an application downloaded onto the OHMD. Intraoperatively, an optical display camera output feed combined with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Software\" title=\"Software\" rel=\"external_link\" target=\"_blank\">software<\/a> allowing for the detection of points of interest enabled faculty to interact with residents during the placement of the penile prosthesis. Both faculty and residents demonstrated a high degree of satisfaction of the ARAUS experience, and it was shown to be an effective tool in training urological surgical technique. Advantages of ARAUS include real-time feedback of residents during surgery and superior visibility and interaction between faculty and residents.<sup id=\"rdp-ebb-cite_ref-HakkyAug15_1-3\" class=\"reference\"><a href=\"#cite_note-HakkyAug15-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-DickeyAug15_3-1\" class=\"reference\"><a href=\"#cite_note-DickeyAug15-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>ARAS has also been applied to the cardiovascular realm. Terry Peters of the University of Western Ontario in London, Canada has teamed up with other researchers at the Robarts Research Institute to implement ARAS towards the goal of improving repairs to the heart's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mitral_valve\" title=\"Mitral valve\" rel=\"external_link\" target=\"_blank\">mitral valve<\/a> and replacement of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Aortic_valve\" title=\"Aortic valve\" rel=\"external_link\" target=\"_blank\">aortic valve<\/a>.<sup id=\"rdp-ebb-cite_ref-PetersAug15_4-1\" class=\"reference\"><a href=\"#cite_note-PetersAug15-4\" rel=\"external_link\">[4]<\/a><\/sup> In an interview for the Medical Augmented Reality Blog, Peters stated that his research team could not only use ARAS to \"[improve] the speed and safety of the cardiac valve repair procedure\"; they also conducted \"the evaluation of an AR environment to plan <a href=\"https:\/\/en.wikipedia.org\/wiki\/Brain_tumor\" title=\"Brain tumor\" rel=\"external_link\" target=\"_blank\">brain-tumor<\/a> removal, and the development of an ARF-enhanced system for ultrasound-guided <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anesthesia#Spinal,_epidural_and_caudal_anesthesia\" title=\"Anesthesia\" rel=\"external_link\" target=\"_blank\">spinal injections<\/a>.\"<sup id=\"rdp-ebb-cite_ref-BichlmeierInt14_5-0\" class=\"reference\"><a href=\"#cite_note-BichlmeierInt14-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-HakkyAug15-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-HakkyAug15_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HakkyAug15_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HakkyAug15_1-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-HakkyAug15_1-3\" rel=\"external_link\"><sup><i><b>d<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Hakky, Tariq; Martinez, Daniel; Lipshultz, Larry; Spiess, Philippe; Carrion, Rafael (2015). \"Augmented Reality Assisted Urologic Surgery (ARAUS): A surgical training tool\". <i>The Journal of Urology<\/i>. <b>193<\/b> (4): e271. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.juro.2015.02.1254\" target=\"_blank\">10.1016\/j.juro.2015.02.1254<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Urology&rft.atitle=Augmented+Reality+Assisted+Urologic+Surgery+%28ARAUS%29%3A+A+surgical+training+tool&rft.volume=193&rft.issue=4&rft.pages=e271&rft.date=2015&rft_id=info%3Adoi%2F10.1016%2Fj.juro.2015.02.1254&rft.aulast=Hakky&rft.aufirst=Tariq&rft.au=Martinez%2C+Daniel&rft.au=Lipshultz%2C+Larry&rft.au=Spiess%2C+Philippe&rft.au=Carrion%2C+Rafael&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAugmented+reality-assisted+surgery\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-Scopis12-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Scopis12_2-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation audio-visual\">Scopis Surgical Navigation (23 November 2012). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.youtube.com\/watch?v=i4emmCcBb4s\" target=\"_blank\"><i>Scopis Augmented Reality: Path guidance to craniopharyngioma<\/i><\/a>. YouTube<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">16 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Scopis+Augmented+Reality%3A+Path+guidance+to+craniopharyngioma&rft.pub=YouTube&rft.date=2012-11-23&rft.au=Scopis+Surgical+Navigation&rft_id=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3Di4emmCcBb4s&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAugmented+reality-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-DickeyAug15-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-DickeyAug15_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-DickeyAug15_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Dickey, R.M.; Srikishen, N.; Lipshultz, L.I.; et al. \"Augmented reality assisted surgery: A urologic training tool\". <i>Asian Journal of Andrology<\/i>. <b>0<\/b> (0): 0. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.4103%2F1008-682X.166436\" target=\"_blank\">10.4103\/1008-682X.166436<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26620455\" target=\"_blank\">26620455<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Asian+Journal+of+Andrology&rft.atitle=Augmented+reality+assisted+surgery%3A+A+urologic+training+tool&rft.volume=0&rft.issue=0&rft.pages=0&rft_id=info%3Adoi%2F10.4103%2F1008-682X.166436&rft_id=info%3Apmid%2F26620455&rft.au=Dickey%2C+R.M.&rft.au=Srikishen%2C+N.&rft.au=Lipshultz%2C+L.I.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAugmented+reality-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-PetersAug15-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-PetersAug15_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-PetersAug15_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Peters, Terry (21 May 2015). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/ewh.ieee.org\/r7\/toronto\/events\/may2115.html\" target=\"_blank\">\"Augmented-Reality Assisted Surgery on the Beating Heart\"<\/a>. IEEE Toronto<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">16 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Augmented-Reality+Assisted+Surgery+on+the+Beating+Heart&rft.pub=IEEE+Toronto&rft.date=2015-05-21&rft.au=Peters%2C+Terry&rft_id=http%3A%2F%2Fewh.ieee.org%2Fr7%2Ftoronto%2Fevents%2Fmay2115.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAugmented+reality-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-BichlmeierInt14-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-BichlmeierInt14_5-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Bichlmeier, Christoph (8 November 2014). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/medicalaugmentedreality.com\/2014\/11\/interview-with-terry-peters-bringing-research-to-clinical-practice\/\" target=\"_blank\">\"Interview with Terry Peters \u2013 Bringing Research to Clinical Practice\"<\/a>. <i>Medical Augmented Reality Blog<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">16 February<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Medical+Augmented+Reality+Blog&rft.atitle=Interview+with+Terry+Peters+%E2%80%93+Bringing+Research+to+Clinical+Practice&rft.date=2014-11-08&rft.au=Bichlmeier%2C+Christoph&rft_id=http%3A%2F%2Fmedicalaugmentedreality.com%2F2014%2F11%2Finterview-with-terry-peters-bringing-research-to-clinical-practice%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAugmented+reality-assisted+surgery\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1328\nCached time: 20181209115931\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.148 seconds\nReal time usage: 0.180 seconds\nPreprocessor visited node count: 313\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 9054\/2097152 bytes\nTemplate argument size: 98\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 14906\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.095\/10.000 seconds\nLua memory usage: 2.46 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 158.681 1 Template:Reflist\n100.00% 158.681 1 -total\n<\/p>\n<pre>74.38% 118.029 2 Template:Cite_journal\n 9.26% 14.686 2 Template:Cite_web\n 4.66% 7.396 1 Template:Cite_AV_media\n 2.00% 3.169 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:45395430-1!canonical and timestamp 20181209115931 and revision id 869146706\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Augmented_Reality_Assisted_Surgery\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214657\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.013 seconds\nReal time usage: 0.159 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 153.562 1 - wikipedia:Augmented_Reality_Assisted_Surgery\n100.00% 153.562 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8224-0!*!*!*!*!*!* and timestamp 20181217214657 and revision id 24374\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Augmented_reality_assisted_surgery\">https:\/\/www.limswiki.org\/index.php\/Augmented_reality_assisted_surgery<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","5e264bde9598d2c256a0d8b5cebe251a_images":[],"5e264bde9598d2c256a0d8b5cebe251a_timestamp":1545083217,"3d2911d947dc7db295e5285b62f25b90_type":"article","3d2911d947dc7db295e5285b62f25b90_title":"Trephine","3d2911d947dc7db295e5285b62f25b90_url":"https:\/\/www.limswiki.org\/index.php\/Trephine","3d2911d947dc7db295e5285b62f25b90_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tTrephine\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t A trephine with a center pin can be seen on the left.\n Dr. John Clarke trepanning a skull, ca. 1664, in one of the earliest American portraits. Clarke has a trephine in his right hand. The painting is in Harvard Medical School.[1]\nA trephine (\/t r \u026a \u02c8 f a\u026a n \/ ; from Greek trypanon, meaning an instrument for boring)[2] is a surgical instrument with a cylindrical blade. It can be of one of several dimensions and designs depending on what it is meant to be used for. They may be specially designed for obtaining a cylindrically shaped core of bone that can be used for tests and bone studies, cutting holes in bones (i.e., the skull) or for cutting out a round piece of the cornea for eye surgery.\nA cylindrically shaped core of bone (or bone biopsy) obtained with a bone marrow trephine is usually examined in the histopathology department of a hospital under a microscope. It shows the pattern and cellularity of the bone marrow as it lay in the bone and is a useful diagnostic tool in certain circumstances such as bone marrow cancer and leukemia.[citation needed ]\n\nSee also \nTrepanning\nTrepanation in Mesoamerica\nInstruments used in general surgery\nReferences \n\n\n^ Holmes, Oliver Wendell (September 18, 2008). Medical Essays. \n\n^ \u03c4\u03c1\u03cd\u03c0\u03b1\u03bd\u03bf\u03bd . Liddell, Henry George; Scott, Robert; A Greek\u2013English Lexicon at the Perseus Project. \n\n\nExternal links \n \"Trepan\". The American Cyclop\u00e6dia. 1879. \n\r\n\n\nThis article related to medical equipment is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Trephine\">https:\/\/www.limswiki.org\/index.php\/Trephine<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 20:00.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 287 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","3d2911d947dc7db295e5285b62f25b90_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Trephine skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Trephine<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ancientgreek_surgical.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Ancientgreek_surgical.jpg\/220px-Ancientgreek_surgical.jpg\" width=\"220\" height=\"184\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Ancientgreek_surgical.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A trephine with a center pin can be seen on the left.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dr_John_Clarke_trepanning_a_skull_operation.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4b\/Dr_John_Clarke_trepanning_a_skull_operation.jpg\/220px-Dr_John_Clarke_trepanning_a_skull_operation.jpg\" width=\"220\" height=\"271\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dr_John_Clarke_trepanning_a_skull_operation.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dr._John_Clarke\" class=\"mw-redirect\" title=\"Dr. John Clarke\" rel=\"external_link\" target=\"_blank\">Dr. John Clarke<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trepanning\" title=\"Trepanning\" rel=\"external_link\" target=\"_blank\">trepanning<\/a> a skull, ca. 1664, in one of the earliest American portraits. Clarke has a trephine in his right hand. The painting is in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Harvard_Medical_School\" title=\"Harvard Medical School\" rel=\"external_link\" target=\"_blank\">Harvard Medical School<\/a>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><\/div><\/div><\/div>\n<p>A <b>trephine<\/b> (<span class=\"nowrap\"><span class=\"IPA nopopups noexcerpt\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Help:IPA\/English\" title=\"Help:IPA\/English\" rel=\"external_link\" target=\"_blank\">\/<span style=\"border-bottom:1px dotted\"><span title=\"'t' in 'tie'\">t<\/span><span title=\"'r' in 'rye'\">r<\/span><span title=\"\/\u026a\/: 'i' in 'kit'\">\u026a<\/span><span title=\"\/\u02c8\/: primary stress follows\">\u02c8<\/span><span title=\"'f' in 'find'\">f<\/span><span title=\"\/a\u026a\/: 'i' in 'tide'\">a\u026a<\/span><span title=\"'n' in 'nigh'\">n<\/span><\/span>\/<\/a><\/span><\/span>; from Greek <i>trypanon<\/i>, meaning an instrument for boring)<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instrument\" title=\"Surgical instrument\" rel=\"external_link\" target=\"_blank\">surgical instrument<\/a> with a cylindrical blade. It can be of one of several dimensions and designs depending on what it is meant to be used for. They may be specially designed for obtaining a cylindrically shaped core of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone\" title=\"Bone\" rel=\"external_link\" target=\"_blank\">bone<\/a> that can be used for tests and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_histomorphometry#Bone_histomorphometry\" class=\"mw-redirect\" title=\"Bone histomorphometry\" rel=\"external_link\" target=\"_blank\">bone studies<\/a>, cutting holes in bones (i.e., the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_skull\" class=\"mw-redirect\" title=\"Human skull\" rel=\"external_link\" target=\"_blank\">skull<\/a>) or for cutting out a round piece of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornea\" title=\"Cornea\" rel=\"external_link\" target=\"_blank\">cornea<\/a> for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eye_surgery\" title=\"Eye surgery\" rel=\"external_link\" target=\"_blank\">eye surgery<\/a>.\n<\/p><p>A cylindrically shaped core of bone (or bone <a href=\"https:\/\/en.wikipedia.org\/wiki\/Biopsy\" title=\"Biopsy\" rel=\"external_link\" target=\"_blank\">biopsy<\/a>) obtained with a bone marrow trephine is usually examined in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Histopathology\" title=\"Histopathology\" rel=\"external_link\" target=\"_blank\">histopathology<\/a> department of a hospital under a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microscope\" title=\"Microscope\" rel=\"external_link\" target=\"_blank\">microscope<\/a>. It shows the pattern and cellularity of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_marrow\" title=\"Bone marrow\" rel=\"external_link\" target=\"_blank\">bone marrow<\/a> as it lay in the bone and is a useful diagnostic tool in certain circumstances such as bone marrow cancer and leukemia.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (April 2014)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Trepanning\" title=\"Trepanning\" rel=\"external_link\" target=\"_blank\">Trepanning<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Trepanation_in_Mesoamerica\" title=\"Trepanation in Mesoamerica\" rel=\"external_link\" target=\"_blank\">Trepanation in Mesoamerica<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Instruments_used_in_general_surgery\" title=\"Instruments used in general surgery\" rel=\"external_link\" target=\"_blank\">Instruments used in general surgery<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Holmes,_Oliver_Wendell\" class=\"mw-redirect\" title=\"Holmes, Oliver Wendell\" rel=\"external_link\" target=\"_blank\">Holmes, Oliver Wendell<\/a> (September 18, 2008). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.gutenberg.org\/ebooks\/2700\" target=\"_blank\"><i>Medical Essays<\/i><\/a>.<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.perseus.tufts.edu\/hopper\/text?doc=Perseus:text:1999.04.0057:entry=tru\/panon\" target=\"_blank\"><span lang=\"grc\" title=\"Ancient Greek language text\">\u03c4\u03c1\u03cd\u03c0\u03b1\u03bd\u03bf\u03bd<\/span><\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Henry_Liddell\" title=\"Henry Liddell\" rel=\"external_link\" target=\"_blank\">Liddell, Henry George<\/a>; <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robert_Scott_(philologist)\" title=\"Robert Scott (philologist)\" rel=\"external_link\" target=\"_blank\">Scott, Robert<\/a>; <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/A_Greek%E2%80%93English_Lexicon\" title=\"A Greek\u2013English Lexicon\" rel=\"external_link\" target=\"_blank\">A Greek\u2013English Lexicon<\/a><\/i> at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Perseus_Project\" title=\"Perseus Project\" rel=\"external_link\" target=\"_blank\">Perseus Project<\/a>.<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><img alt=\"Wikisource\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/4c\/Wikisource-logo.svg\/12px-Wikisource-logo.svg.png\" width=\"12\" height=\"13\" \/> <cite class=\"citation encyclopaedia\">\"<a href=\"https:\/\/en.wikisource.org\/wiki\/The_American_Cyclop%C3%A6dia_(1879)\/Trepan\" class=\"extiw\" title=\"s:The American Cyclop\u00e6dia (1879)\/Trepan\" rel=\"external_link\" target=\"_blank\">Trepan<\/a>\". <i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_American_Cyclop%C3%A6dia\" class=\"mw-redirect\" title=\"The American Cyclop\u00e6dia\" rel=\"external_link\" target=\"_blank\">The American Cyclop\u00e6dia<\/a><\/i>. 1879.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Trepan&rft.btitle=The+American+Cyclop%C3%A6dia&rft.date=1879&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATrephine\" class=\"Z3988\"><\/span><\/li><\/ul>\n<p><br \/>\n<\/p>\n\n<p><!-- \nNewPP limit report\nParsed by mw1332\nCached time: 20181215205531\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.276 seconds\nReal time usage: 0.390 seconds\nPreprocessor visited node count: 450\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 9312\/2097152 bytes\nTemplate argument size: 623\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 2510\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.207\/10.000 seconds\nLua memory usage: 10.33 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 361.919 1 -total\n<\/p>\n<pre>47.89% 173.335 1 Template:Reflist\n44.66% 161.633 1 Template:LSJ\n43.70% 158.145 1 Template:Lang\n20.93% 75.738 1 Template:Cite_AmCyc\n19.34% 70.002 1 Template:Cite_encyclopedia\n15.32% 55.456 1 Template:IPAc-en\n10.24% 37.070 1 Template:Citation_needed\n 8.48% 30.689 1 Template:Fix\n 5.33% 19.307 1 Template:Medical-equipment-stub\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1669789-1!canonical and timestamp 20181215205531 and revision id 856477753\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Trephine\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214657\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.034 seconds\nReal time usage: 0.173 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 168.050 1 - wikipedia:Trephine\n100.00% 168.050 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8562-0!*!*!*!*!*!* and timestamp 20181217214656 and revision id 24990\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Trephine\">https:\/\/www.limswiki.org\/index.php\/Trephine<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","3d2911d947dc7db295e5285b62f25b90_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Ancientgreek_surgical.jpg\/440px-Ancientgreek_surgical.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4b\/Dr_John_Clarke_trepanning_a_skull_operation.jpg\/440px-Dr_John_Clarke_trepanning_a_skull_operation.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Filled_Syringe_icon.svg\/60px-Filled_Syringe_icon.svg.png"],"3d2911d947dc7db295e5285b62f25b90_timestamp":1545083216,"4ecb22262c78bf2dca1ad28cc1bfec99_type":"article","4ecb22262c78bf2dca1ad28cc1bfec99_title":"Surgical stapler","4ecb22262c78bf2dca1ad28cc1bfec99_url":"https:\/\/www.limswiki.org\/index.php\/Surgical_staple","4ecb22262c78bf2dca1ad28cc1bfec99_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgical staple\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article includes a list of references, but its sources remain unclear because it has insufficient inline citations. Please help to improve this article by introducing more precise citations. (April 2016) (Learn how and when to remove this template message)\n 34 surgical staples closing scalp following craniotomy\n Projectional radiograph of surgical staples\nSurgical staples are specialized staples used in surgery in place of sutures to close skin wounds, connect or remove parts of the bowels or lungs. The use of staples over sutures reduces the local inflammatory response, width of the wound, and the time it takes to close.[1]\nA more recent development, from the 1990s, uses clips instead of staples for some applications; this does not require the staple to penetrate.[2]\n\nContents \n\n1 History \n2 Types and applications \n3 Removal of skin staples \n4 See also \n5 References \n\n\nHistory \nThe technique was pioneered by \"father of surgical stapling\", Hungarian surgeon Humor Hultl.[3][4] Hultl's prototype stapler of 1908 weighed 8 pounds (3.6 kg), and required two hours to assemble and load.\nThe technology was refined in the 1950s in the Soviet Union, allowing for the first commercially produced re-usable stapling devices for creation of bowel and vascular anastomoses.[5] Mark M. Ravitch, brought a sample of stapling device after attending a surgical conference in USSR, and introduced it to entrepreneur Leon C. Hirsch, who founded the United States Surgical Corporation in 1964 to manufacture surgical staplers under its Auto Suture brand.[6] Until the late 1970s USSC had the market essentially to itself, but in 1977 Johnson & Johnson's Ethicon brand entered the market and today both are widely used, along with competitors from the Far East. USSC was bought by Tyco Healthcare in 1998, which became Covidien on June 29, 2007.\nSafety and patency of mechanical (stapled) bowel anastomoses has been widely studied. It is generally the case in such studies that sutured anastomoses are either comparable or less prone to leakage.[7] It is possible that this is the result of recent advances in suture technology, along with increasingly risk-conscious surgical practice. Certainly modern synthetic sutures are more predictable and less prone to infection than catgut, silk and linen, which were the main suture materials used up to the 1990s.\nOne key feature of intestinal staplers is that the edges of the stapler act as a haemostat, compressing the edges of the wound and closing blood vessels during the stapling process. Recent studies have shown that with current suturing techniques there is no significant difference in outcome between hand sutured and mechanical anastomoses (including clips), but mechanical anastomoses are significantly quicker to perform.[8][2]\nIn patients that are subjected to pulmonary resections where lung tissue is sealed with staplers, there is often postoperative air leaks.[9] Alternative techniques to seal lung tissue are currently investigated.[10]\n\nTypes and applications \nThis section may be too long to read and navigate comfortably. Please consider splitting content into sub-articles, condensing it, or adding or removing subheadings. (June 2014)\n Laparoscopic cholecystectomy.\n Close-up demonstration of a surgical skin stapler.\nThe first commercial staplers were made of stainless steel with titanium staples loaded into reloadable staple cartridges.\nModern surgical staplers are either disposable and made of plastic, or reusable and made of stainless steel. Both types are generally loaded using disposable cartridges.\nThe staple line may be straight, curved or circular. Circular staplers are used for end-to-end anastomosis after bowel resection or, somewhat more controversially, in esophagogastric surgery.[11] The instruments may be used in either open or laparoscopic surgery, different instruments are used for each application. Laparoscopic staplers are longer, thinner, and may be articulated to allow for access from a restricted number of trocar ports.\nSome staplers incorporate a knife, to complete excision and anastomosis in a single operation. \nStaplers are used to close both internal and skin wounds. Skin staples are usually applied using a disposable stapler, and removed with a specialized staple remover. Staplers are also used in vertical banded gastroplasty surgery (popularly known as \"stomach stapling\").\n\n<\/p>\n Vascular stapler for reducing warm ischemia in organ transplantation. With this model each stapler end can be mounted on donor and recipient by independent surgical teams without care for reciprocal orientation, being the maximal possible vascular axis torsion \u226430\u00b0. Activating guide-wire is connected just immediately before firing (video)\nWhile devices for circular end-to-end anastomosis of digestive tract are widely used, in spite of intensive research [12][13][14] circular staplers for vascular anastomosis never had yet significant impact on standard hand (Carrel) suture technique. Apart from the different modality of coupling of vascular (everted) in respect to digestive (inverted) stumps, the main basic reason could be that, particularly for small vessels, the manuality and precision required just for positioning on vascular stumps and actioning any device cannot be significantly inferior to that required to carry out the standard hand suture, then making of little utility the use of any device. An exception to that however could be organ transplantation where these two phases, i.e.device positioning at the vascular stumps and device actioning, can be carried out in different time, by different surgical team, in safe conditions when the time required does not influence donor organ preservation, i.e. at the back table in cold ischemia condition for the donor organ and after native organ removal in the recipient. This is finalized to make as brief as possible the donor organ dangerous warm ischemia phase that can be contained in the couple of minutes or less necessary just to connect the device's ends and actioning the stapler.\nAlthough most surgical staples are made of titanium, stainless steel is more often used in some skin staples and clips. Titanium produces less reaction with the immune system and, being non-ferrous, does not interfere significantly with MRI scanners, although some imaging artifacts may result. Synthetic absorbable (bioabsorbable) staples are also now becoming available, based on polyglycolic acid, as with many synthetic absorbable sutures.\nTitanium staples are not suspected of causing nickel reactions because nickel is rarely if ever used in titanium alloys.[dubious   – discuss ]\n\nRemoval of skin staples \nWhere skin staples are used to seal a skin wound it will be necessary to remove the staples after an appropriate healing period, usually between 5 and 10 days, depending on the location of the wound and other factors. The skin staple remover is a small manual device which consists of a shoe or plate that is sufficiently narrow and thin to insert under the skin staple. The active part is a small blade that when hand-pressure is exerted it pushes down on the staple and pushes it through a slot in the shoe and deforms the staple into an 'M' shape to facilitate its removal, although in an emergency it is possible to remove them with a pair of artery forceps.[15]\nSkin staple removers are manufactured in many shapes and forms,[16] some disposable and some reusable.\n\nSee also \nInstruments used in general surgery\nReferences \n\n\n^ Iavazzo, Christos; Gkegkes, Ioannis D.; Vouloumanou, Evridiki K.; Mamais, Ioannis; Peppas, George; Falagas, Matthew E. (September 2011). \"Sutures versus staples for the management of surgical wounds: a meta-analysis of randomized controlled trials\". The American Surgeon. 77 (9): 1206\u20131221. ISSN 1555-9823. PMID 21944632. \n\n^ a b Chughtai, T.; Chen, L. Q.; Salasidis, G.; Nguyen, D.; Tchervenkov, C.; Morin, J. F. (November 2000). \"Clips versus suture technique: is there a difference?\". The Canadian Journal of Cardiology. 16 (11): 1403\u20131407. ISSN 0828-282X. PMID 11109037. \n\n^ Non-suture methods of vascular anastomosis, British Journal of Surgery, 19 Feb 2003: Volume 90, Issue 3, Pages 261 - 271 \n\n^ Circular vascular stapling in coronary surgery,\nKonstantinov, Annals of Thoracic Surgery, 2004; 78: 369-373 \n\n^ [1] \n\n^ History of United States Surgical Corporation \n\n^ Brundage Susan I (2001). \"Stapled versus Sutured Gastrointestinal Anastomoses in the Trauma Patient: A Multicenter Trial\". Journal of Trauma-Injury Infection & Critical Care. 51 (6): 1054\u20131061. doi:10.1097\/00005373-200112000-00005. \n\n^ Surgery Today, Volume 34, Number 2 \/ February, 2004 \n\n^ Venuta, F; Rendina, EA; De Giacomo, T; Flaishman, I; Guarino, E; Ciccone, AM; Ricci, C (April 1998). \"Technique to reduce air leaks after pulmonary lobectomy\". European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 13 (4): 361\u20134. PMID 9641332. \n\n^ Guedes, Rog\u00e9rio Luizari; H\u00f6glund, Odd Viking; Brum, Juliana Sperotto; Borg, Niklas; Dornbusch, Peterson Triches (3 January 2018). \"Resorbable Self-Locking Implant for Lung Lobectomy Through Video-Assisted Thoracoscopic Surgery: First Live Animal Application\". Surgical Innovation. 25 (2): 158\u2013164. doi:10.1177\/1553350617751293. \n\n^ European Journal of Cardio-Thoracic Surgery, Volume 25, Issue 6, June 2004, Pages 1097-1101 \n\n^ Nazari S et al. A new vascular stapler for pulmonary artery anastomosis in experimental single lung trasnplantation.Video, Proceedings of the 4th Annual Meeting of The Association for Cardio-Thoracic Surgery, Naples, Sept 16-19, 1990 \n\n^ \"Evaluation of an aortic stapler for an open aortic anastomosis\". The Journal of Cardiovascular Surgery (Torino). 48 (5): 659\u201365. Oct 2007 – via Minerva Medica. \n\n^ \"Intravascular Stapler for \"Open\" Aortic Surgery: Preliminary Results\". European Journal of Vascular and Endovascular Surgery. 33 (4): 408\u201311. Apr 2007. doi:10.1016\/j.ejvs.2006.10.019 – via Science Direct. \n\n^ Teoh, MK; Bird, DA (1 September 1987), \"Removal of skin staples in an emergency\", Ann R Coll Surg Engl, Annals of the Royal College of Surgeons of England, 69: 222\u20134, PMC 2498551 , PMID 3314634 \n\n^ https:\/\/www.google.co.uk\/search?q=skin+staple+removers&biw=1173&bih=813&source=lnms&tbm=isch&sa=X&ved=0CAcQ_AUoAmoVChMI8_nK9aTsxgIViXI-Ch21EAPc#imgrc=EgdRfi49foQSwM%3A \n\n\nvteSurgical instrumentsDissectingScalpels\nLaser scalpel\nRF knife\nLancets\nListon knife\nCatlin\nVon Graefe knife\nSurgical scissors:\nBandage scissors\nIris scissors\nMayo scissors\nMetzenbaum scissors\nTenotomy scissors\nOther:\nRongeur\nCurette\nOsteotome\nDrill bits\nRasps\nTrocars\nDrills\nCranial drills\nDental drills\nDermatomes\nGrasping (forceps)\nBulldogs forceps\nHemostat\nObstetric\nVulsellum\nTenaculum\nDebakey forceps\nClamping\nFoerster clamp\nHemostat\nPennington clamp\nAortic cross-clamp\nGomco clamp\nAllis clamp\nRetracting\/viewing\nRetractors: Senn retractor\nRib spreader\nAccessory\/otherExamination\/prep:\nDilators\nSpecula\nFiber optic endoscopes\nHead mirror\nSuction:\nYankauer suction tip\n\nIrrigation and injection needles\nMeasurement devices:\nrulers and calipers\nDrain:\nJackson-Pratt drain\nPenrose drain\nOther:\nSurgical staplers\nPeriodontal probe\nSurgical suture\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_staple\">https:\/\/www.limswiki.org\/index.php\/Surgical_staple<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation 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LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","4ecb22262c78bf2dca1ad28cc1bfec99_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Surgical_staple skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surgical staple<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:34_surgical_staples,_craniotomy.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/41\/34_surgical_staples%2C_craniotomy.jpg\/220px-34_surgical_staples%2C_craniotomy.jpg\" width=\"220\" height=\"141\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:34_surgical_staples,_craniotomy.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>34 surgical staples closing scalp following <a href=\"https:\/\/en.wikipedia.org\/wiki\/Craniotomy\" title=\"Craniotomy\" rel=\"external_link\" target=\"_blank\">craniotomy<\/a><\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Medical-staples.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a3\/Medical-staples.jpg\/220px-Medical-staples.jpg\" width=\"220\" height=\"148\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Medical-staples.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Projectional_radiograph\" class=\"mw-redirect\" title=\"Projectional radiograph\" rel=\"external_link\" target=\"_blank\">Projectional radiograph<\/a> of surgical staples<\/div><\/div><\/div>\n<p><b>Surgical staples<\/b> are specialized <a href=\"https:\/\/en.wikipedia.org\/wiki\/Staple_(fastener)\" title=\"Staple (fastener)\" rel=\"external_link\" target=\"_blank\">staples<\/a> used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a> in place of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_suture\" title=\"Surgical suture\" rel=\"external_link\" target=\"_blank\">sutures<\/a> to close <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin\" title=\"Skin\" rel=\"external_link\" target=\"_blank\">skin<\/a> wounds, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anastomosis\" title=\"Anastomosis\" rel=\"external_link\" target=\"_blank\">connect<\/a> or remove parts of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bowel\" class=\"mw-redirect\" title=\"Bowel\" rel=\"external_link\" target=\"_blank\">bowels<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lung\" title=\"Lung\" rel=\"external_link\" target=\"_blank\">lungs<\/a>. The use of staples over sutures reduces the local inflammatory response, width of the wound, and the time it takes to close.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>A more recent development, from the 1990s, uses clips instead of staples for some applications; this does not require the staple to penetrate.<sup id=\"rdp-ebb-cite_ref-:0_2-0\" class=\"reference\"><a href=\"#cite_note-:0-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The technique was pioneered by \"father of surgical stapling\", Hungarian surgeon .<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Hultl's prototype stapler of 1908 weighed 8 pounds (3.6 kg), and required two hours to assemble and load.\n<\/p><p>The technology was refined in the 1950s in the Soviet Union, allowing for the first commercially produced re-usable stapling devices for creation of bowel and vascular anastomoses.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Mark M. Ravitch, brought a sample of stapling device after attending a surgical conference in USSR, and introduced it to entrepreneur , who founded the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States_Surgical_Corporation\" class=\"mw-redirect\" title=\"United States Surgical Corporation\" rel=\"external_link\" target=\"_blank\">United States Surgical Corporation<\/a> in 1964 to manufacture surgical staplers under its Auto Suture brand.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> Until the late 1970s USSC had the market essentially to itself, but in 1977 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Johnson_%26_Johnson\" title=\"Johnson & Johnson\" rel=\"external_link\" target=\"_blank\">Johnson & Johnson<\/a>'s <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ethicon_Inc.\" title=\"Ethicon Inc.\" rel=\"external_link\" target=\"_blank\">Ethicon<\/a> brand entered the market and today both are widely used, along with competitors from the Far East. USSC was bought by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tyco_Healthcare\" class=\"mw-redirect\" title=\"Tyco Healthcare\" rel=\"external_link\" target=\"_blank\">Tyco Healthcare<\/a> in 1998, which became <a href=\"https:\/\/en.wikipedia.org\/wiki\/Covidien\" title=\"Covidien\" rel=\"external_link\" target=\"_blank\">Covidien<\/a> on June 29, 2007.\n<\/p><p>Safety and patency of mechanical (stapled) bowel <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anastomosis\" title=\"Anastomosis\" rel=\"external_link\" target=\"_blank\">anastomoses<\/a> has been widely studied. It is generally the case in such studies that sutured anastomoses are either comparable or less prone to leakage.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> It is possible that this is the result of recent advances in suture technology, along with increasingly risk-conscious surgical practice. Certainly modern synthetic sutures are more predictable and less prone to infection than <a href=\"https:\/\/en.wikipedia.org\/wiki\/Catgut\" title=\"Catgut\" rel=\"external_link\" target=\"_blank\">catgut<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silk\" title=\"Silk\" rel=\"external_link\" target=\"_blank\">silk<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Linen\" title=\"Linen\" rel=\"external_link\" target=\"_blank\">linen<\/a>, which were the main suture materials used up to the 1990s.\n<\/p><p>One key feature of intestinal staplers is that the edges of the stapler act as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Haemostat\" class=\"mw-redirect\" title=\"Haemostat\" rel=\"external_link\" target=\"_blank\">haemostat<\/a>, compressing the edges of the wound and closing blood vessels during the stapling process. Recent studies have shown that with current suturing techniques there is no significant difference in outcome between hand sutured and mechanical anastomoses (including clips), but mechanical anastomoses are significantly quicker to perform.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-:0_2-1\" class=\"reference\"><a href=\"#cite_note-:0-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>In patients that are subjected to pulmonary resections where lung tissue is sealed with staplers, there is often postoperative air leaks.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup> Alternative techniques to seal lung tissue are currently investigated.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types_and_applications\">Types and applications<\/span><\/h2>\n\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gallbladderop.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Gallbladderop.jpg\/220px-Gallbladderop.jpg\" width=\"220\" height=\"204\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Gallbladderop.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Laparoscopic <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cholecystectomy\" title=\"Cholecystectomy\" rel=\"external_link\" target=\"_blank\">cholecystectomy<\/a>.<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Skin_stapler_closeup.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/31\/Skin_stapler_closeup.jpg\/220px-Skin_stapler_closeup.jpg\" width=\"220\" height=\"104\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Skin_stapler_closeup.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Close-up demonstration of a surgical skin stapler.<\/div><\/div><\/div>\n<p>The first commercial staplers were made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a> with titanium staples loaded into reloadable staple cartridges.\n<\/p><p>Modern surgical staplers are either disposable and made of plastic, or reusable and made of stainless steel. Both types are generally loaded using disposable cartridges.\n<\/p><p>The staple line may be straight, curved or circular. Circular staplers are used for end-to-end <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anastomosis#Medicine\" title=\"Anastomosis\" rel=\"external_link\" target=\"_blank\">anastomosis<\/a> after <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bowel_resection\" title=\"Bowel resection\" rel=\"external_link\" target=\"_blank\">bowel resection<\/a> or, somewhat more controversially, in esophagogastric <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a>.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup> The instruments may be used in either open or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laparoscopic_surgery\" class=\"mw-redirect\" title=\"Laparoscopic surgery\" rel=\"external_link\" target=\"_blank\">laparoscopic surgery<\/a>, different instruments are used for each application. Laparoscopic staplers are longer, thinner, and may be articulated to allow for access from a restricted number of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Trocar\" title=\"Trocar\" rel=\"external_link\" target=\"_blank\">trocar<\/a> ports.\n<\/p><p>Some staplers incorporate a knife, to complete <a href=\"https:\/\/en.wiktionary.org\/wiki\/excision\" class=\"extiw\" title=\"wikt:excision\" rel=\"external_link\" target=\"_blank\">excision<\/a> and anastomosis in a single operation. \n<p>Staplers are used to close both internal and skin wounds. Skin staples are usually applied using a disposable stapler, and removed with a specialized staple remover. Staplers are also used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vertical_banded_gastroplasty_surgery\" title=\"Vertical banded gastroplasty surgery\" rel=\"external_link\" target=\"_blank\">vertical banded gastroplasty surgery<\/a> (popularly known as \"stomach stapling\").\n<\/p>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vascular_stapler.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/61\/Vascular_stapler.jpg\/220px-Vascular_stapler.jpg\" width=\"220\" height=\"116\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vascular_stapler.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Vascular stapler for reducing warm ischemia in organ transplantation. With this model each stapler end can be mounted on donor and recipient by independent surgical teams without care for reciprocal orientation, being the maximal possible vascular axis torsion \u226430\u00b0. Activating guide-wire is connected just immediately before firing <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fondazionecarrel.org\/carrel\/vasc\/files\/stapler\/stapler.htm\" target=\"_blank\">(video)<\/a><\/div><\/div><\/div>\n<p>While devices for circular end-to-end anastomosis of digestive tract are widely used, in spite of intensive research <sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup> circular staplers for vascular anastomosis never had yet significant impact on standard hand (Carrel) suture technique. Apart from the different modality of coupling of vascular (everted) in respect to digestive (inverted) stumps, the main basic reason could be that, particularly for small vessels, the manuality and precision required just for positioning on vascular stumps and actioning any device cannot be significantly inferior to that required to carry out the standard hand suture, then making of little utility the use of any device. An exception to that however could be organ transplantation where these two phases, i.e.device positioning at the vascular stumps and device actioning, can be carried out in different time, by different surgical team, in safe conditions when the time required does not influence donor organ preservation, i.e. at the back table in cold ischemia condition for the donor organ and after native organ removal in the recipient. This is finalized to make as brief as possible the donor organ dangerous warm ischemia phase that can be contained in the couple of minutes or less necessary just to connect the device's ends and actioning the stapler.\n<\/p><p>Although most surgical staples are made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a> is more often used in some skin staples and clips. Titanium produces less reaction with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Immune\" class=\"mw-redirect\" title=\"Immune\" rel=\"external_link\" target=\"_blank\">immune<\/a> system and, being non-ferrous, does not interfere significantly with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">MRI<\/a> scanners, although some imaging artifacts may result. Synthetic absorbable (bioabsorbable) staples are also now becoming available, based on <a href=\"https:\/\/en.wikipedia.org\/wiki\/Polyglycolic_acid\" class=\"mw-redirect\" title=\"Polyglycolic acid\" rel=\"external_link\" target=\"_blank\">polyglycolic acid<\/a>, as with many synthetic absorbable sutures.\n<\/p><p>Titanium staples are not suspected of causing nickel reactions because nickel is rarely if ever used in titanium alloys.<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Accuracy_dispute#Disputed_statement\" title=\"Wikipedia:Accuracy dispute\" rel=\"external_link\" target=\"_blank\"><span title=\"The material near this tag is possibly inaccurate or nonfactual. (June 2014)\">dubious<\/span><\/a> <span class=\"metadata\"> – <a href=\"https:\/\/en.wikipedia.org\/wiki\/Talk:Surgical_staple#Dubious\" title=\"Talk:Surgical staple\" rel=\"external_link\" target=\"_blank\">discuss<\/a><\/span><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Removal_of_skin_staples\">Removal of skin staples<\/span><\/h2>\n<p>Where skin staples are used to seal a skin wound it will be necessary to remove the staples after an appropriate healing period, usually between 5 and 10 days, depending on the location of the wound and other factors. The skin staple remover is a small manual device which consists of a shoe or plate that is sufficiently narrow and thin to insert under the skin staple. The active part is a small blade that when hand-pressure is exerted it pushes down on the staple and pushes it through a slot in the shoe and deforms the staple into an 'M' shape to facilitate its removal, although in an emergency it is possible to remove them with a pair of artery forceps.<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup>\nSkin staple removers are manufactured in many shapes and forms,<sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> some disposable and some reusable.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Instruments_used_in_general_surgery\" title=\"Instruments used in general surgery\" rel=\"external_link\" target=\"_blank\">Instruments used in general surgery<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Iavazzo, Christos; Gkegkes, Ioannis D.; Vouloumanou, Evridiki K.; Mamais, Ioannis; Peppas, George; Falagas, Matthew E. (September 2011). \"Sutures versus staples for the management of surgical wounds: a meta-analysis of randomized controlled trials\". <i>The American Surgeon<\/i>. <b>77<\/b> (9): 1206\u20131221. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/1555-9823\" target=\"_blank\">1555-9823<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21944632\" target=\"_blank\">21944632<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+American+Surgeon&rft.atitle=Sutures+versus+staples+for+the+management+of+surgical+wounds%3A+a+meta-analysis+of+randomized+controlled+trials&rft.volume=77&rft.issue=9&rft.pages=1206-1221&rft.date=2011-09&rft_id=info%3Apmid%2F21944632&rft.issn=1555-9823&rft.aulast=Iavazzo&rft.aufirst=Christos&rft.au=Gkegkes%2C+Ioannis+D.&rft.au=Vouloumanou%2C+Evridiki+K.&rft.au=Mamais%2C+Ioannis&rft.au=Peppas%2C+George&rft.au=Falagas%2C+Matthew+E.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+staple\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-:0-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-:0_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-:0_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Chughtai, T.; Chen, L. Q.; Salasidis, G.; Nguyen, D.; Tchervenkov, C.; Morin, J. F. (November 2000). \"Clips versus suture technique: is there a difference?\". <i>The Canadian Journal of Cardiology<\/i>. <b>16<\/b> (11): 1403\u20131407. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Serial_Number\" title=\"International Standard Serial Number\" rel=\"external_link\" target=\"_blank\">ISSN<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.worldcat.org\/issn\/0828-282X\" target=\"_blank\">0828-282X<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11109037\" target=\"_blank\">11109037<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Canadian+Journal+of+Cardiology&rft.atitle=Clips+versus+suture+technique%3A+is+there+a+difference%3F&rft.volume=16&rft.issue=11&rft.pages=1403-1407&rft.date=2000-11&rft_id=info%3Apmid%2F11109037&rft.issn=0828-282X&rft.aulast=Chughtai&rft.aufirst=T.&rft.au=Chen%2C+L.+Q.&rft.au=Salasidis%2C+G.&rft.au=Nguyen%2C+D.&rft.au=Tchervenkov%2C+C.&rft.au=Morin%2C+J.+F.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+staple\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>Non-suture methods of vascular anastomosis<\/i>, British Journal of Surgery, 19 Feb 2003: Volume 90, Issue 3, Pages 261 - 271<\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><i>Circular vascular stapling in coronary surgery<\/i>,\nKonstantinov, Annals of Thoracic Surgery, 2004; 78: 369-373<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external autonumber\" href=\"http:\/\/ats.ctsnetjournals.org\/cgi\/content\/full\/78\/1\/369\" target=\"_blank\">[1]<\/a><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.fundinguniverse.com\/company-histories\/United-States-Surgical-Corporation-Company-History.html\" target=\"_blank\">History of United States Surgical Corporation<\/a><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Brundage Susan I (2001). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.jtrauma.com\/pt\/re\/jtrauma\/abstract.00005373-200112000-00005.htm;jsessionid=HGcPqDY6ny12TtcpJwhGzx4hymlFGkJn1hpPvntqS1J2C1GLL2w3!1458925248!181195629!8091!-1\" target=\"_blank\">\"Stapled versus Sutured Gastrointestinal Anastomoses in the Trauma Patient: A Multicenter Trial\"<\/a>. <i>Journal of Trauma-Injury Infection & Critical Care<\/i>. <b>51<\/b> (6): 1054\u20131061. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1097%2F00005373-200112000-00005\" target=\"_blank\">10.1097\/00005373-200112000-00005<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Trauma-Injury+Infection+%26+Critical+Care&rft.atitle=Stapled+versus+Sutured+Gastrointestinal+Anastomoses+in+the+Trauma+Patient%3A+A+Multicenter+Trial&rft.volume=51&rft.issue=6&rft.pages=1054-1061&rft.date=2001&rft_id=info%3Adoi%2F10.1097%2F00005373-200112000-00005&rft.au=Brundage+Susan+I&rft_id=http%3A%2F%2Fwww.jtrauma.com%2Fpt%2Fre%2Fjtrauma%2Fabstract.00005373-200112000-00005.htm%3Bjsessionid%3DHGcPqDY6ny12TtcpJwhGzx4hymlFGkJn1hpPvntqS1J2C1GLL2w3%211458925248%21181195629%218091%21-1&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+staple\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.springerlink.com\/content\/yycjvdad177gwet8\/\" target=\"_blank\"><i>Surgery Today<\/i>, Volume 34, Number 2 \/ February, 2004<\/a><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Venuta, F; 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H\u00f6glund, Odd Viking; Brum, Juliana Sperotto; Borg, Niklas; Dornbusch, Peterson Triches (3 January 2018). \"Resorbable Self-Locking Implant for Lung Lobectomy Through Video-Assisted Thoracoscopic Surgery: First Live Animal Application\". <i>Surgical Innovation<\/i>. <b>25<\/b> (2): 158\u2013164. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1177%2F1553350617751293\" target=\"_blank\">10.1177\/1553350617751293<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Surgical+Innovation&rft.atitle=Resorbable+Self-Locking+Implant+for+Lung+Lobectomy+Through+Video-Assisted+Thoracoscopic+Surgery%3A+First+Live+Animal+Application&rft.volume=25&rft.issue=2&rft.pages=158-164&rft.date=2018-01-03&rft_id=info%3Adoi%2F10.1177%2F1553350617751293&rft.aulast=Guedes&rft.aufirst=Rog%C3%A9rio+Luizari&rft.au=H%C3%B6glund%2C+Odd+Viking&rft.au=Brum%2C+Juliana+Sperotto&rft.au=Borg%2C+Niklas&rft.au=Dornbusch%2C+Peterson+Triches&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+staple\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science?_ob=ArticleURL&_udi=B6T35-4C0TN7T-B&_user=10&_coverDate=06%2F30%2F2004&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=bdeaf02b388cd206dfc979b56f1d0b8d\" target=\"_blank\">European Journal of Cardio-Thoracic Surgery, Volume 25, Issue 6, June 2004, Pages 1097-1101<\/a><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Nazari S et al. A new vascular stapler for pulmonary artery anastomosis in experimental single lung trasnplantation.Video, Proceedings of the 4th Annual Meeting of The Association for Cardio-Thoracic Surgery, Naples, Sept 16-19, 1990<\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.minervamedica.it\/en\/journals\/cardiovascular-surgery\/article.php?cod=R37Y2007N05A0659\" target=\"_blank\">\"Evaluation of an aortic stapler for an open aortic anastomosis\"<\/a>. <i>The Journal of Cardiovascular Surgery (Torino)<\/i>. <b>48<\/b> (5): 659\u201365. Oct 2007 – via Minerva Medica.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Cardiovascular+Surgery+%28Torino%29.&rft.atitle=Evaluation+of+an+aortic+stapler+for+an+open+aortic+anastomosis&rft.volume=48&rft.issue=5&rft.pages=659-65&rft.date=2007-10&rft_id=http%3A%2F%2Fwww.minervamedica.it%2Fen%2Fjournals%2Fcardiovascular-surgery%2Farticle.php%3Fcod%3DR37Y2007N05A0659&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+staple\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S1078588406006058\" target=\"_blank\">\"Intravascular Stapler for \"Open\" Aortic Surgery: Preliminary Results\"<\/a>. <i>European Journal of Vascular and Endovascular Surgery<\/i>. <b>33<\/b> (4): 408\u201311. Apr 2007. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ejvs.2006.10.019\" target=\"_blank\">10.1016\/j.ejvs.2006.10.019<\/a> – via Science Direct.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Journal+of+Vascular+and+Endovascular+Surgery&rft.atitle=Intravascular+Stapler+for+%22Open%22+Aortic+Surgery%3A+Preliminary+Results&rft.volume=33&rft.issue=4&rft.pages=408-11&rft.date=2007-04&rft_id=info%3Adoi%2F10.1016%2Fj.ejvs.2006.10.019&rft_id=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS1078588406006058&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+staple\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFTeohBird1987\" class=\"citation\">Teoh, MK; Bird, DA (1 September 1987), \"Removal of skin staples in an emergency\", <i>Ann R Coll Surg Engl<\/i>, Annals of the Royal College of Surgeons of England, <b>69<\/b>: 222\u20134, <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2498551\" target=\"_blank\">2498551<\/a><\/span>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3314634\" target=\"_blank\">3314634<\/a><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ann+R+Coll+Surg+Engl&rft.atitle=Removal+of+skin+staples+in+an+emergency&rft.volume=69&rft.pages=222-4&rft.date=1987-09-01&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2498551&rft_id=info%3Apmid%2F3314634&rft.aulast=Teoh&rft.aufirst=MK&rft.au=Bird%2C+DA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+staple\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"#imgrc=EgdRfi49foQSwM%3A\">https:\/\/www.google.co.uk\/search?q=skin+staple+removers&biw=1173&bih=813&source=lnms&tbm=isch&sa=X&ved=0CAcQ_AUoAmoVChMI8_nK9aTsxgIViXI-Ch21EAPc#imgrc=EgdRfi49foQSwM%3A<\/a><\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1319\nCached time: 20181129135400\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.292 seconds\nReal time usage: 0.388 seconds\nPreprocessor visited node count: 1096\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 52509\/2097152 bytes\nTemplate argument size: 821\/2097152 bytes\nHighest expansion depth: 12\/40\nExpensive parser function count: 6\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 27462\/5000000 bytes\nNumber of Wikibase entities loaded: 3\/400\nLua time usage: 0.165\/10.000 seconds\nLua memory usage: 5.56 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 322.786 1 -total\n<\/p>\n<pre>50.05% 161.562 1 Template:Reflist\n39.82% 128.523 7 Template:Cite_journal\n22.24% 71.775 1 Template:More_footnotes\n16.03% 51.727 2 Template:Ambox\n10.61% 34.253 1 Template:Convert\n 7.08% 22.864 1 Template:Dubious\n 6.15% 19.864 1 Template:Fix\n 5.48% 17.694 3 Template:Navbox\n 5.23% 16.883 1 Template:Surgical_instruments\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:9487577-1!canonical and timestamp 20181129135400 and revision id 843083595\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_staple\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214656\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.152 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 145.133 1 - wikipedia:Surgical_staple\n100.00% 145.133 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8561-0!*!*!*!*!*!* and timestamp 20181217214656 and revision id 24989\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_staple\">https:\/\/www.limswiki.org\/index.php\/Surgical_staple<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","4ecb22262c78bf2dca1ad28cc1bfec99_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/41\/34_surgical_staples%2C_craniotomy.jpg\/440px-34_surgical_staples%2C_craniotomy.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/a\/a3\/Medical-staples.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/Gallbladderop.jpg\/440px-Gallbladderop.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/31\/Skin_stapler_closeup.jpg\/440px-Skin_stapler_closeup.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/6\/61\/Vascular_stapler.jpg\/440px-Vascular_stapler.jpg"],"4ecb22262c78bf2dca1ad28cc1bfec99_timestamp":1545083216,"17d73fcb12dc52873dd739f6359e8c4b_type":"article","17d73fcb12dc52873dd739f6359e8c4b_title":"Surgical scissors","17d73fcb12dc52873dd739f6359e8c4b_url":"https:\/\/www.limswiki.org\/index.php\/Surgical_scissors","17d73fcb12dc52873dd739f6359e8c4b_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgical scissors\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tThis article does not cite any sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (December 2010) (Learn how and when to remove this template message)\nSurgical scissors are surgical instruments usually used for cutting. They include bandage scissors, dissecting scissors, iris scissors, operating scissors, stitch scissors, tenotomy scissors, Metzenbaum scissors, plastic surgery scissors, and Mayo scissors. Surgical scissors are usually made of very hard stainless steel for ongoing toughness. Some scissors have tungsten carbide reinforcements along their cutting edges. The hardness of this material allows the manufacturers to create sharper edges, which allows for easier and smoother cuts and keeps the scissors sharp for longer.\n\nContents \n\n1 Types \n2 Material \n3 Gallery \n4 See also \n5 References \n\n\nTypes \nThere are two types of scissors used in surgeries. \n\nRing scissors look much like standard utility scissors with two finger loops.\nSpring forceps are small scissors used mostly in eye surgery or microsurgery. The handles end in flat springs connected with a pivot joint. The cutting action is achieved by pressing the handles together. As the pressure is released, the spring action opens the jaws.\nScissors are available in various configurations like\n\nBlunt\/blunt blades\nBlunt\/sharp blades\nSharp\/sharp blades\nMaterial \nUsually material of surgical scissor are stainless steel, zirconia ceramic, nitinol and titanium.\n\nGallery \n\n\t\t\n\t\t\t\n\t\t\t\nMetzenbaum scissors\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nMayo scissors\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nBandage Scissors\n\n\t\t\t\n\t\t\n\nSee also \n\n\n\nWikimedia Commons has media related to Surgical scissors.\nTrauma shears\nBandage scissors\nHemostat, a surgical clamp resembling scissors\nNeedle holder, an instrument resembling scissors used to hold a suturing needle\nReferences \n\n\nThis article related to medical equipment is a stub. You can help Wikipedia by expanding it.vte\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_scissors\">https:\/\/www.limswiki.org\/index.php\/Surgical_scissors<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:57.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 433 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","17d73fcb12dc52873dd739f6359e8c4b_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Surgical_scissors skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surgical scissors<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\">\n<p><b>Surgical scissors<\/b> are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instrument\" title=\"Surgical instrument\" rel=\"external_link\" target=\"_blank\">surgical instruments<\/a> usually used for cutting. They include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bandage_scissors\" title=\"Bandage scissors\" rel=\"external_link\" target=\"_blank\">bandage scissors<\/a>, , <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iris_scissors\" title=\"Iris scissors\" rel=\"external_link\" target=\"_blank\">iris scissors<\/a>, , , <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tenotomy_scissors\" title=\"Tenotomy scissors\" rel=\"external_link\" target=\"_blank\">tenotomy scissors<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metzenbaum_scissors\" title=\"Metzenbaum scissors\" rel=\"external_link\" target=\"_blank\">Metzenbaum scissors<\/a>, , and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mayo_scissors\" title=\"Mayo scissors\" rel=\"external_link\" target=\"_blank\">Mayo scissors<\/a>. Surgical scissors are usually made of very hard <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a> for ongoing toughness. Some scissors have <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tungsten_carbide\" title=\"Tungsten carbide\" rel=\"external_link\" target=\"_blank\">tungsten carbide<\/a> reinforcements along their cutting edges. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hardness\" title=\"Hardness\" rel=\"external_link\" target=\"_blank\">hardness<\/a> of this material allows the manufacturers to create sharper edges, which allows for easier and smoother cuts and keeps the scissors sharp for longer.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<p>There are two types of scissors used in surgeries. \n<\/p>\n<ul><li>Ring scissors look much like standard utility scissors with two finger loops.<\/li>\n<li>Spring forceps are small scissors used mostly in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Eye_surgery\" title=\"Eye surgery\" rel=\"external_link\" target=\"_blank\">eye surgery<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Microsurgery\" title=\"Microsurgery\" rel=\"external_link\" target=\"_blank\">microsurgery<\/a>. The handles end in flat springs connected with a pivot joint. The cutting action is achieved by pressing the handles together. As the pressure is released, the spring action opens the jaws.<\/li><\/ul>\n<p>Scissors are available in various configurations like\n<\/p>\n<ul><li>Blunt\/blunt blades<\/li>\n<li>Blunt\/sharp blades<\/li>\n<li>Sharp\/sharp blades<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Material\">Material<\/span><\/h2>\n<p>Usually material of surgical scissor are <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_stainless_steel\" title=\"Surgical stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a>, zirconia ceramic, nitinol and titanium.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Gallery\">Gallery<\/span><\/h2>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:35px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Metzenbaum_scissors_04.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/01\/Metzenbaum_scissors_04.jpg\/120px-Metzenbaum_scissors_04.jpg\" width=\"120\" height=\"80\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Metzenbaum_scissors\" title=\"Metzenbaum scissors\" rel=\"external_link\" target=\"_blank\">Metzenbaum scissors<\/a>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_scissors_07.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/Surgical_scissors_07.JPG\/120px-Surgical_scissors_07.JPG\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mayo_scissors\" title=\"Mayo scissors\" rel=\"external_link\" target=\"_blank\">Mayo scissors<\/a>\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Bandage_Scissors.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2f\/Bandage_Scissors.JPG\/120px-Bandage_Scissors.JPG\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Bandage Scissors\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Trauma_shears\" title=\"Trauma shears\" rel=\"external_link\" target=\"_blank\">Trauma shears<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bandage_scissors\" title=\"Bandage scissors\" rel=\"external_link\" target=\"_blank\">Bandage scissors<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemostat\" title=\"Hemostat\" rel=\"external_link\" target=\"_blank\">Hemostat<\/a>, a surgical clamp resembling scissors<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Needle_holder\" title=\"Needle holder\" rel=\"external_link\" target=\"_blank\">Needle holder<\/a>, an instrument resembling scissors used to hold a suturing needle<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1274\nCached time: 20181205031100\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.144 seconds\nReal time usage: 0.235 seconds\nPreprocessor visited node count: 334\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 9621\/2097152 bytes\nTemplate argument size: 340\/2097152 bytes\nHighest expansion depth: 14\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 2274\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.074\/10.000 seconds\nLua memory usage: 2.75 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 210.637 1 -total\n<\/p>\n<pre>45.32% 95.466 1 Template:Commons_category\n39.28% 82.732 1 Template:Commons\n37.84% 79.699 1 Template:Sister_project\n35.79% 75.392 1 Template:Side_box\n32.47% 68.404 1 Template:Unreferenced\n31.92% 67.239 2 Template:If_then_show\n23.24% 48.946 1 Template:Ambox\n 8.54% 17.980 1 Template:Medical-equipment-stub\n 7.45% 15.700 1 Template:Asbox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:30040768-1!canonical and timestamp 20181205031100 and revision id 859102756\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_scissors\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214656\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.144 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 138.639 1 - wikipedia:Surgical_scissors\n100.00% 138.639 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8560-0!*!*!*!*!*!* and timestamp 20181217214656 and revision id 24988\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_scissors\">https:\/\/www.limswiki.org\/index.php\/Surgical_scissors<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","17d73fcb12dc52873dd739f6359e8c4b_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/01\/Metzenbaum_scissors_04.jpg\/240px-Metzenbaum_scissors_04.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/Surgical_scissors_07.JPG\/240px-Surgical_scissors_07.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/2f\/Bandage_Scissors.JPG\/240px-Bandage_Scissors.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/9a\/Filled_Syringe_icon.svg\/60px-Filled_Syringe_icon.svg.png"],"17d73fcb12dc52873dd739f6359e8c4b_timestamp":1545083216,"a0bea2b6776e6a13c6234028907149c5_type":"article","a0bea2b6776e6a13c6234028907149c5_title":"Surgical mask","a0bea2b6776e6a13c6234028907149c5_url":"https:\/\/www.limswiki.org\/index.php\/Surgical_mask","a0bea2b6776e6a13c6234028907149c5_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgical mask\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor other uses, see Respirator.\n OR personnel wearing surgical mask at California Pacific Medical Center.\nA surgical mask, also known as a procedure mask, is intended to be worn by health professionals during surgery and during nursing to catch the bacteria shed in liquid droplets and aerosols from the wearer's mouth and nose. They are not designed to protect the wearer from inhaling airborne bacteria or virus particles and are less effective than respirators, such as N95 or NIOSH masks, which provide better protection due to their material, shape and tight seal.\nSurgical masks are popularly worn by the general public in East Asian countries to reduce the chance of spreading airborne diseases.\n\nContents \n\n1 Definition \n2 Usage \n\n2.1 Health care workers \n2.2 General public \n\n\n3 Design \n4 See also \n5 References \n\n\nDefinition \nA surgical mask, or procedure mask, is intended to be worn by health professionals during surgery and certain health care procedures[1] to catch microorganisms shed in liquid droplets and aerosols from the wearer's mouth and nose. Its first recorded use was by the French surgeon Paul Berger during an 1897 operation in Paris.[citation needed ]\nModern surgical masks are made from paper or other non-woven material and should be discarded after each use.[2]\nA surgical mask is not to be confused with a respirator and is not certified as such. Surgical masks are not designed to protect the wearer from inhaling airborne bacteria or virus particles and are less effective than respirators, which are designed for this purpose.[3]\n\nUsage \n Without the manifold buffers afforded by a surgical mask, airborne diseases can be easily transferred via respiratory droplets\nHealth care workers \n A Kimberly-Clark procedure mask.[4] Note the full facial shielding and the Droplet Isolation protocol signage.\nSimple surgical masks protect wearers from being splashed in the mouth with body fluids, and prevent transmission of body fluids from the wearer to others, e.g. the patient. They also remind wearers not to touch their mouth or nose, which could otherwise transfer viruses and bacteria after having touched a contaminated surface (fomite). They can also reduce the spread of infectious liquid droplets (carrying bacteria or viruses) that are created when the wearer coughs or sneezes[citation needed ]. There is no clear evidence that disposable face masks worn by members of the surgical team would reduce the risk of wound infections after clean surgical procedures.[5] Cotton and gauze masks do not serve as surgical masks as they do not offer adequate filtration of microbes.[citation needed ]\nEvidence supports the effectiveness of surgical masks in reducing the risk of infection among other healthcare workers and in the community.[6] In community settings, facemasks must be coupled with other measures such as avoiding close contact and maintaining good hand hygiene to reduce the risk of getting influenza according to the Centers for Disease Control and Prevention in its guidance regarding the 2009 swine flu outbreak.[2]\nFor healthcare workers, safety guidelines recommend the wearing of a face-fit tested respirator mask conforming to United States standard NIOSH N95 or European standard EN 149 FFP3 in the vicinity of pandemic-flu patients, to reduce the exposure of the wearer to potentially infectious aerosols and airborne liquid droplets.[7][8]\nThe U.S Centers for Disease Control and Prevention (CDC) provides information on manufacturers' products, and the importance of correct fitting of such masks (respirators). A printable factsheet has been designed for issue to those unaccustomed to respirator use.[9]\n\n<\/p>\n A man wearing a surgical mask in public in Japan.\nGeneral public \n During the 1918 flu pandemic, a street car conductor in Seattle, USA refuses a person who attempts to board without wearing a mask.\nSurgical masks are popularly worn by the general public in East Asian countries to reduce the chance of spreading airborne diseases; in Japan, it is common to wear a face mask whilst ill to avoid infecting others in public settings.[10] In Japan and Taiwan, it is common to see these masks worn while ill, as a show of consideration for others and social responsibility.[11]\nSurgical masks were widely used in China, Hong Kong, Vietnam, and Toronto, Ontario, Canada during outbreaks of the SARS, during the 2007 bird flu pandemic in Japan, and during the 2009 flu pandemic featuring swine flu and the H1N1 virus in the United States and Mexico City.[citation needed ]\n\nDesign \n Typical 3-ply surgical masks. The top one has the right side up and the bottom one up side down. The edge with double stitches is designed to cover the nose, and a metal wire is concealed within so the mask could be fitted to the contour of the nasal bridge.\nThe design of the surgical masks depends on the mode; usually the masks are 3 ply\/3 layers. This 3 ply material is made up from a melt-blown material placed between non-woven fabric. The melt-blown material acts as the filter that stops microbes from entering or exiting the mask. Most surgical masks feature pleats or folds. Commonly, 3 pleats are used allowing the user to expand the mask so it covers the area from the nose to the chin.\nThere are 3 different ways to secure the masks. The most popular is the ear loop, where a string like material is attached to the mask and placed behind the ears. The other is the tie-on and the head band. The tie-on straps consist of four non-woven straps that are tied behind the head. The head band is an elastic strap that is placed behind the head.[citation needed ]\nSurgical masks with decorative designs are popular in countries in which they are worn in public.[citation needed ]\n\nSee also \nDust mask\nReferences \n\n\n^ Procedure mask. nursingcenter.com \n\n^ a b \"Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission\". Centers for Disease Control and Prevention. May 27, 2009. Unless otherwise specified, the term \"facemasks\" refers to disposable facemasks cleared by the U.S. Food and Drug Administration (FDA) for use as medical devices. This includes facemasks labeled as surgical, dental, medical procedure, isolation, or laser masks... Facemasks should be used once and then thrown away in the trash. \n\n^ \"Respiratory Protection Against Airborne Infectious Agents for Health Care Workers: Do surgical masks protect workers?\" (OSH Answers Fact Sheets). Canadian Centre for Occupational Health and Safety. 2017-02-28. Retrieved 2017-02-28 . \n\n^ \/2014\/12\/08\/dr-mark-dowell-urges-flu-shots-despite-mutated-h3n2-strain\/ \n\n^ Vincent, Marina; Edwards, Peggy (26 April 2016). \"Disposable surgical face masks for preventing surgical wound infection in clean surgery\". Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. 4: CD002929. doi:10.1002\/14651858.cd002929.pub3. PMID 27115326. Retrieved 29 April 2016 . \n\n^ MacIntyre, CR; Chughtai, AA (9 April 2015). \"Facemasks for the prevention of infection in healthcare and community settings\". BMJ (Clinical research ed.). 350: h694. doi:10.1136\/bmj.h694. PMID 25858901. \n\n^ \"Interim guidance on planning for the use of surgical masks and respirators in health care settings during an influenza pandemic\" (PDF) . U.S. Department of Health & Human Services. October 2006. Archived from the original (PDF) on 2016-03-04. \n\n^ \"Working with highly pathogenic avian influenza virus\". UK Health and Safety Executive. Retrieved August 2, 2014 . \n\n^ \"N95 Factsheet\". Centers for Disease Control and Prevention. Archived from the original on November 11, 2009. \n\n^ Juliet Hindell (May 30, 1999). \"Japan's war on germs and smells\". BBC Online. \n\n^ Negrin, Matt (2009-04-26). \"For allergy and flu season, the Japanese turn to surgical masks\". Winnipeg Free Press. Retrieved 2017-09-29 . \n\n\n\n\n\nWikimedia Commons has media related to Surgical masks.\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_mask\">https:\/\/www.limswiki.org\/index.php\/Surgical_mask<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:56.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 612 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","a0bea2b6776e6a13c6234028907149c5_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Surgical_mask skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surgical mask<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Respirator\" title=\"Respirator\" rel=\"external_link\" target=\"_blank\">Respirator<\/a>.<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CPMC_Surgery_(412142792).jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/db\/CPMC_Surgery_%28412142792%29.jpg\/220px-CPMC_Surgery_%28412142792%29.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:CPMC_Surgery_(412142792).jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>OR personnel wearing surgical mask at <a href=\"https:\/\/en.wikipedia.org\/wiki\/California_Pacific_Medical_Center\" title=\"California Pacific Medical Center\" rel=\"external_link\" target=\"_blank\">California Pacific Medical Center<\/a>.<\/div><\/div><\/div>\n<p>A <b>surgical mask<\/b>, also known as a <b>procedure mask<\/b>, is intended to be worn by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_professional\" title=\"Health professional\" rel=\"external_link\" target=\"_blank\">health professionals<\/a> during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a> and during nursing to catch the bacteria shed in liquid droplets and aerosols from the wearer's mouth and nose. They are not designed to protect the wearer from inhaling airborne bacteria or virus particles and are less effective than respirators, such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/NIOSH_air_filtration_rating\" title=\"NIOSH air filtration rating\" rel=\"external_link\" target=\"_blank\">N95<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/NIOSH\" class=\"mw-redirect\" title=\"NIOSH\" rel=\"external_link\" target=\"_blank\">NIOSH<\/a> masks, which provide better protection due to their material, shape and tight seal.\nSurgical masks are popularly worn by the general public in East Asian countries to reduce the chance of spreading <a href=\"https:\/\/en.wikipedia.org\/wiki\/Airborne_disease\" title=\"Airborne disease\" rel=\"external_link\" target=\"_blank\">airborne diseases<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Definition\">Definition<\/span><\/h2>\n<p>A surgical mask, or procedure mask, is intended to be worn by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_professional\" title=\"Health professional\" rel=\"external_link\" target=\"_blank\">health professionals<\/a> during <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a> and certain health care procedures<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> to catch microorganisms shed in liquid droplets and aerosols from the wearer's mouth and nose. Its first recorded use was by the French surgeon <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paul_Berger\" title=\"Paul Berger\" rel=\"external_link\" target=\"_blank\">Paul Berger<\/a> during an 1897 operation in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paris\" title=\"Paris\" rel=\"external_link\" target=\"_blank\">Paris<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\nModern surgical masks are made from paper or other non-woven material and should be discarded after each use.<sup id=\"rdp-ebb-cite_ref-h1n1masks_2-0\" class=\"reference\"><a href=\"#cite_note-h1n1masks-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>A surgical mask is not to be confused with a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Respirator\" title=\"Respirator\" rel=\"external_link\" target=\"_blank\">respirator<\/a> and is not certified as such. Surgical masks are not designed to protect the wearer from inhaling airborne bacteria or virus particles and are less effective than respirators, which are designed for this purpose.<sup id=\"rdp-ebb-cite_ref-canada_3-0\" class=\"reference\"><a href=\"#cite_note-canada-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Usage\">Usage<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sneeze.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/77\/Sneeze.JPG\/220px-Sneeze.JPG\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sneeze.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Without the manifold buffers afforded by a surgical mask, airborne diseases can be easily transferred via respiratory droplets<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"Health_care_workers\">Health care workers<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:KimberlyClarkSurgicalMaskBoiseVAMedicalCenter.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a7\/KimberlyClarkSurgicalMaskBoiseVAMedicalCenter.jpg\/170px-KimberlyClarkSurgicalMaskBoiseVAMedicalCenter.jpg\" width=\"170\" height=\"226\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:KimberlyClarkSurgicalMaskBoiseVAMedicalCenter.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kimberly-Clark\" title=\"Kimberly-Clark\" rel=\"external_link\" target=\"_blank\">Kimberly-Clark<\/a> procedure mask.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> Note the full facial shielding and the Droplet <a href=\"https:\/\/en.wikipedia.org\/wiki\/Isolation_(health_care)\" title=\"Isolation (health care)\" rel=\"external_link\" target=\"_blank\">Isolation<\/a> protocol signage.<\/div><\/div><\/div>\n<p>Simple surgical masks protect wearers from being splashed in the mouth with body fluids, and prevent transmission of body fluids from the wearer to others, e.g. the patient. They also remind wearers not to touch their mouth or nose, which could otherwise transfer viruses and bacteria after having touched a contaminated surface (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Fomite_(term)\" class=\"mw-redirect\" title=\"Fomite (term)\" rel=\"external_link\" target=\"_blank\">fomite<\/a>). They can also reduce the spread of infectious liquid droplets (carrying bacteria or viruses) that are created when the wearer coughs or sneezes<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (October 2016)\">citation needed<\/span><\/a><\/i>]<\/sup>. There is no clear evidence that disposable face masks worn by members of the surgical team would reduce the risk of wound infections after clean surgical procedures.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup> Cotton and gauze masks do not serve as surgical masks as they do not offer adequate filtration of microbes.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Evidence supports the effectiveness of surgical masks in reducing the risk of infection among other healthcare workers and in the community.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> In community settings, facemasks must be coupled with other measures such as avoiding close contact and maintaining good hand hygiene to reduce the risk of getting influenza according to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention\" title=\"Centers for Disease Control and Prevention\" rel=\"external_link\" target=\"_blank\">Centers for Disease Control and Prevention<\/a> in its guidance regarding the <a href=\"https:\/\/en.wikipedia.org\/wiki\/2009_swine_flu_outbreak\" class=\"mw-redirect\" title=\"2009 swine flu outbreak\" rel=\"external_link\" target=\"_blank\">2009 swine flu outbreak<\/a>.<sup id=\"rdp-ebb-cite_ref-h1n1masks_2-1\" class=\"reference\"><a href=\"#cite_note-h1n1masks-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p><p>For healthcare workers, safety guidelines recommend the wearing of a face-fit tested <a href=\"https:\/\/en.wikipedia.org\/wiki\/Respirator\" title=\"Respirator\" rel=\"external_link\" target=\"_blank\">respirator<\/a> mask conforming to United States standard <a href=\"https:\/\/en.wikipedia.org\/wiki\/NIOSH\" class=\"mw-redirect\" title=\"NIOSH\" rel=\"external_link\" target=\"_blank\">NIOSH<\/a> N95 or European standard EN 149 FFP3 in the vicinity of pandemic-flu patients, to reduce the exposure of the wearer to potentially infectious aerosols and airborne liquid droplets.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<p>The U.S <a href=\"https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention\" title=\"Centers for Disease Control and Prevention\" rel=\"external_link\" target=\"_blank\">Centers for Disease Control and Prevention<\/a> (CDC) provides information on manufacturers' products, and the importance of correct fitting of such masks (respirators). A printable factsheet has been designed for issue to those unaccustomed to respirator use.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Maninamedicanmask-tokyoarea-nov6-2018.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/32\/Maninamedicanmask-tokyoarea-nov6-2018.jpg\/220px-Maninamedicanmask-tokyoarea-nov6-2018.jpg\" width=\"220\" height=\"191\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Maninamedicanmask-tokyoarea-nov6-2018.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A man wearing a surgical mask in public in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Japan\" title=\"Japan\" rel=\"external_link\" target=\"_blank\">Japan<\/a>.<\/div><\/div><\/div>\n<h3><span class=\"mw-headline\" id=\"General_public\">General public<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:165-WW-269B-11-trolley-l.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/06\/165-WW-269B-11-trolley-l.jpg\/170px-165-WW-269B-11-trolley-l.jpg\" width=\"170\" height=\"235\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:165-WW-269B-11-trolley-l.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>During the <a href=\"https:\/\/en.wikipedia.org\/wiki\/1918_flu_pandemic\" class=\"mw-redirect\" title=\"1918 flu pandemic\" rel=\"external_link\" target=\"_blank\">1918 flu pandemic<\/a>, a street car conductor in Seattle, USA refuses a person who attempts to board without wearing a mask.<\/div><\/div><\/div>\n<p>Surgical masks are popularly worn by the general public in East Asian countries to reduce the chance of spreading <a href=\"https:\/\/en.wikipedia.org\/wiki\/Airborne_disease\" title=\"Airborne disease\" rel=\"external_link\" target=\"_blank\">airborne diseases<\/a>; in Japan, it is common to wear a face mask whilst ill to avoid infecting others in public settings.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> In Japan and Taiwan, it is common to see these masks worn while ill, as a show of consideration for others and social responsibility.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p><p>Surgical masks were widely used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/China\" title=\"China\" rel=\"external_link\" target=\"_blank\">China<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hong_Kong\" title=\"Hong Kong\" rel=\"external_link\" target=\"_blank\">Hong Kong<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vietnam\" title=\"Vietnam\" rel=\"external_link\" target=\"_blank\">Vietnam<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Toronto,_Ontario\" class=\"mw-redirect\" title=\"Toronto, Ontario\" rel=\"external_link\" target=\"_blank\">Toronto, Ontario<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Canada\" title=\"Canada\" rel=\"external_link\" target=\"_blank\">Canada<\/a> during outbreaks of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Severe_acute_respiratory_syndrome\" title=\"Severe acute respiratory syndrome\" rel=\"external_link\" target=\"_blank\">SARS<\/a>, during the 2007 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Influenza_A_virus_subtype_H5N1\" title=\"Influenza A virus subtype H5N1\" rel=\"external_link\" target=\"_blank\">bird flu<\/a> pandemic in Japan, and during the <a href=\"https:\/\/en.wikipedia.org\/wiki\/2009_flu_pandemic\" title=\"2009 flu pandemic\" rel=\"external_link\" target=\"_blank\">2009 flu pandemic<\/a> featuring <a href=\"https:\/\/en.wikipedia.org\/wiki\/Swine_flu\" class=\"mw-redirect\" title=\"Swine flu\" rel=\"external_link\" target=\"_blank\">swine flu<\/a> and the <a href=\"https:\/\/en.wikipedia.org\/wiki\/H1N1\" class=\"mw-redirect\" title=\"H1N1\" rel=\"external_link\" target=\"_blank\">H1N1<\/a> virus in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/United_States\" title=\"United States\" rel=\"external_link\" target=\"_blank\">United States<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mexico_City\" title=\"Mexico City\" rel=\"external_link\" target=\"_blank\">Mexico City<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Design\">Design<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blossom_3_Ply_Bacterial_Filter_Masks_Elestic_Earloop_Face_Mask_Surgical_Masks_a.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1c\/Blossom_3_Ply_Bacterial_Filter_Masks_Elestic_Earloop_Face_Mask_Surgical_Masks_a.jpg\/220px-Blossom_3_Ply_Bacterial_Filter_Masks_Elestic_Earloop_Face_Mask_Surgical_Masks_a.jpg\" width=\"220\" height=\"208\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Blossom_3_Ply_Bacterial_Filter_Masks_Elestic_Earloop_Face_Mask_Surgical_Masks_a.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Typical 3-ply surgical masks. The top one has the right side up and the bottom one up side down. The edge with double stitches is designed to cover the nose, and a metal wire is concealed within so the mask could be fitted to the contour of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nasal_bridge\" title=\"Nasal bridge\" rel=\"external_link\" target=\"_blank\">nasal bridge<\/a>.<\/div><\/div><\/div>\n<p>The design of the surgical masks depends on the mode; usually the masks are 3 ply\/3 layers. This 3 ply material is made up from a melt-blown material placed between non-woven fabric. The melt-blown material acts as the filter that stops microbes from entering or exiting the mask. Most surgical masks feature pleats or folds. Commonly, 3 pleats are used allowing the user to expand the mask so it covers the area from the nose to the chin.\nThere are 3 different ways to secure the masks. The most popular is the ear loop, where a string like material is attached to the mask and placed behind the ears. The other is the tie-on and the head band. The tie-on straps consist of four non-woven straps that are tied behind the head. The head band is an elastic strap that is placed behind the head.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p><p>Surgical masks with decorative designs are popular in countries in which they are worn in public.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (March 2017)\">citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dust_mask\" title=\"Dust mask\" rel=\"external_link\" target=\"_blank\">Dust mask<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.nursingcenter.com\/lnc\/static?pageid=811924\" target=\"_blank\">Procedure mask.<\/a> nursingcenter.com<\/span>\n<\/li>\n<li id=\"cite_note-h1n1masks-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-h1n1masks_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-h1n1masks_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/h1n1flu\/masks.htm\" target=\"_blank\">\"Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention\" title=\"Centers for Disease Control and Prevention\" rel=\"external_link\" target=\"_blank\">Centers for Disease Control and Prevention<\/a>. May 27, 2009. <q>Unless otherwise specified, the term \"facemasks\" refers to <b>disposable<\/b> facemasks cleared by the U.S. Food and Drug Administration (FDA) for use as medical devices. This includes facemasks labeled as surgical, dental, medical procedure, isolation, or laser masks... <b>Facemasks should be used once and then thrown away in the trash.<\/b><\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Interim+Recommendations+for+Facemask+and+Respirator+Use+to+Reduce+Novel+Influenza+A+%28H1N1%29+Virus+Transmission&rft.pub=Centers+for+Disease+Control+and+Prevention&rft.date=2009-05-27&rft_id=https%3A%2F%2Fwww.cdc.gov%2Fh1n1flu%2Fmasks.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-canada-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-canada_3-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.ccohs.ca\/oshanswers\/prevention\/respiratory_protection.html\" target=\"_blank\">\"Respiratory Protection Against Airborne Infectious Agents for Health Care Workers: Do surgical masks protect workers?\"<\/a> (OSH Answers Fact Sheets). Canadian Centre for Occupational Health and Safety. 2017-02-28<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-02-28<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Respiratory+Protection+Against+Airborne+Infectious+Agents+for+Health+Care+Workers%3A+Do+surgical+masks+protect+workers%3F&rft.pub=Canadian+Centre+for+Occupational+Health+and+Safety&rft.date=2017-02-28&rft_id=http%3A%2F%2Fwww.ccohs.ca%2Foshanswers%2Fprevention%2Frespiratory_protection.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/wyomingmedicalcenter.org\/pulse\/2014\/12\/08\/dr-mark-dowell-urges-flu-shots-despite-mutated-h3n2-strain\/\" target=\"_blank\">\/2014\/12\/08\/dr-mark-dowell-urges-flu-shots-despite-mutated-h3n2-strain\/<\/a><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Vincent, Marina; Edwards, Peggy (26 April 2016). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/14651858.CD002929.pub3\/full\" target=\"_blank\">\"Disposable surgical face masks for preventing surgical wound infection in clean surgery\"<\/a>. <i>Cochrane Database of Systematic Reviews<\/i>. John Wiley & Sons, Ltd. <b>4<\/b>: CD002929. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1002%2F14651858.cd002929.pub3\" target=\"_blank\">10.1002\/14651858.cd002929.pub3<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27115326\" target=\"_blank\">27115326<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">29 April<\/span> 2016<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cochrane+Database+of+Systematic+Reviews&rft.atitle=Disposable+surgical+face+masks+for+preventing+surgical+wound+infection+in+clean+surgery&rft.volume=4&rft.pages=CD002929&rft.date=2016-04-26&rft_id=info%3Adoi%2F10.1002%2F14651858.cd002929.pub3&rft_id=info%3Apmid%2F27115326&rft.aulast=Vincent&rft.aufirst=Marina&rft.au=Edwards%2C+Peggy&rft_id=http%3A%2F%2Fonlinelibrary.wiley.com%2Fdoi%2F10.1002%2F14651858.CD002929.pub3%2Ffull&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">MacIntyre, CR; Chughtai, AA (9 April 2015). \"Facemasks for the prevention of infection in healthcare and community settings\". <i>BMJ (Clinical research ed.)<\/i>. <b>350<\/b>: h694. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1136%2Fbmj.h694\" target=\"_blank\">10.1136\/bmj.h694<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25858901\" target=\"_blank\">25858901<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BMJ+%28Clinical+research+ed.%29&rft.atitle=Facemasks+for+the+prevention+of+infection+in+healthcare+and+community+settings.&rft.volume=350&rft.pages=h694&rft.date=2015-04-09&rft_id=info%3Adoi%2F10.1136%2Fbmj.h694&rft_id=info%3Apmid%2F25858901&rft.aulast=MacIntyre&rft.aufirst=CR&rft.au=Chughtai%2C+AA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20160304190243\/http:\/\/home.nyc.gov\/html\/doh\/downloads\/pdf\/bhpp\/bhpp-interrim-maskguide120106.pdf\" target=\"_blank\">\"Interim guidance on planning for the use of surgical masks and respirators in health care settings during an influenza pandemic\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/U.S._Department_of_Health_%26_Human_Services\" class=\"mw-redirect\" title=\"U.S. Department of Health & Human Services\" rel=\"external_link\" target=\"_blank\">U.S. Department of Health & Human Services<\/a>. October 2006. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/home.nyc.gov\/html\/doh\/downloads\/pdf\/bhpp\/bhpp-interrim-maskguide120106.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2016-03-04.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Interim+guidance+on+planning+for+the+use+of+surgical+masks+and+respirators+in+health+care+settings+during+an+influenza+pandemic&rft.pub=U.S.+Department+of+Health+%26+Human+Services&rft.date=2006-10&rft_id=http%3A%2F%2Fhome.nyc.gov%2Fhtml%2Fdoh%2Fdownloads%2Fpdf%2Fbhpp%2Fbhpp-interrim-maskguide120106.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hse.gov.uk\/biosafety\/diseases\/avianflu.htm\" target=\"_blank\">\"Working with highly pathogenic avian influenza virus\"<\/a>. UK Health and Safety Executive<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">August 2,<\/span> 2014<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Working+with+highly+pathogenic+avian+influenza+virus&rft.pub=UK+Health+and+Safety+Executive&rft_id=http%3A%2F%2Fwww.hse.gov.uk%2Fbiosafety%2Fdiseases%2Favianflu.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20091111221111\/http:\/\/www.cdc.gov\/h1n1flu\/eua\/summary-factsheet.htm\" target=\"_blank\">\"N95 Factsheet\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention\" title=\"Centers for Disease Control and Prevention\" rel=\"external_link\" target=\"_blank\">Centers for Disease Control and Prevention<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/h1n1flu\/eua\/summary-factsheet.htm\" target=\"_blank\">the original<\/a> on November 11, 2009.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=N95+Factsheet&rft.pub=Centers+for+Disease+Control+and+Prevention&rft_id=https%3A%2F%2Fwww.cdc.gov%2Fh1n1flu%2Feua%2Fsummary-factsheet.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Juliet Hindell (May 30, 1999). <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/news.bbc.co.uk\/2\/hi\/programmes\/from_our_own_correspondent\/354321.stm\" target=\"_blank\">\"Japan's war on germs and smells\"<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/BBC_Online\" title=\"BBC Online\" rel=\"external_link\" target=\"_blank\">BBC Online<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Japan%27s+war+on+germs+and+smells&rft.pub=BBC+Online&rft.date=1999-05-30&rft.au=Juliet+Hindell&rft_id=http%3A%2F%2Fnews.bbc.co.uk%2F2%2Fhi%2Fprogrammes%2Ffrom_our_own_correspondent%2F354321.stm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\">Negrin, Matt (2009-04-26). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.winnipegfreepress.com\/arts-and-life\/life\/health\/For-allergy-and-flu-season_-the-Japanese-turn-to-surgical-masks-43738507.html\" target=\"_blank\">\"For allergy and flu season, the Japanese turn to surgical masks\"<\/a>. Winnipeg Free Press<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2017-09-29<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=For+allergy+and+flu+season%2C+the+Japanese+turn+to+surgical+masks&rft.date=2009-04-26&rft.aulast=Negrin&rft.aufirst=Matt&rft_id=https%3A%2F%2Fwww.winnipegfreepress.com%2Farts-and-life%2Flife%2Fhealth%2FFor-allergy-and-flu-season_-the-Japanese-turn-to-surgical-masks-43738507.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASurgical+mask\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1269\nCached time: 20181212004335\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.336 seconds\nReal time usage: 0.454 seconds\nPreprocessor visited node count: 1365\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 30596\/2097152 bytes\nTemplate argument size: 3158\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 3\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 26006\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.213\/10.000 seconds\nLua memory usage: 4.44 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 404.983 1 -total\n<\/p>\n<pre>48.55% 196.620 1 Template:Reflist\n28.21% 114.247 6 Template:Cite_web\n25.29% 102.401 6 Template:Citation_needed\n22.29% 90.270 6 Template:Fix\n14.87% 60.226 1 Template:Commons_category\n12.54% 50.776 12 Template:Category_handler\n11.74% 47.565 2 Template:Cite_journal\n 9.33% 37.796 1 Template:Other_uses\n 8.26% 33.456 6 Template:Delink\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:821829-1!canonical and timestamp 20181212004335 and revision id 873241440\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_mask\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214655\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.027 seconds\nReal time usage: 0.174 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 167.906 1 - wikipedia:Surgical_mask\n100.00% 167.906 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8559-0!*!*!*!*!*!* and timestamp 20181217214655 and revision id 24987\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_mask\">https:\/\/www.limswiki.org\/index.php\/Surgical_mask<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","a0bea2b6776e6a13c6234028907149c5_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/db\/CPMC_Surgery_%28412142792%29.jpg\/440px-CPMC_Surgery_%28412142792%29.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/77\/Sneeze.JPG\/440px-Sneeze.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/a\/a7\/KimberlyClarkSurgicalMaskBoiseVAMedicalCenter.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/32\/Maninamedicanmask-tokyoarea-nov6-2018.jpg\/440px-Maninamedicanmask-tokyoarea-nov6-2018.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/06\/165-WW-269B-11-trolley-l.jpg\/340px-165-WW-269B-11-trolley-l.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1c\/Blossom_3_Ply_Bacterial_Filter_Masks_Elestic_Earloop_Face_Mask_Surgical_Masks_a.jpg\/440px-Blossom_3_Ply_Bacterial_Filter_Masks_Elestic_Earloop_Face_Mask_Surgical_Masks_a.jpg"],"a0bea2b6776e6a13c6234028907149c5_timestamp":1545083215,"3633b9ae4a7a31327d7d10b337925b43_type":"article","3633b9ae4a7a31327d7d10b337925b43_title":"Speculum (medical)","3633b9ae4a7a31327d7d10b337925b43_url":"https:\/\/www.limswiki.org\/index.php\/Speculum_(medical)","3633b9ae4a7a31327d7d10b337925b43_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSpeculum (medical)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tMedical device for investigating body orifices by direct vision\n The disposable bivalved plastic vaginal speculum is used in office gynecology\nA speculum (Latin for \"mirror\"; plural specula or speculums) is a medical tool for investigating body orifices, with a form dependent on the orifice for which it is designed. In old texts, the speculum may also be referred to as a diopter or dioptra.[1] Like an endoscope, a speculum allows a view inside the body; endoscopes, however, tend to have optics while a speculum is intended for direct vision.\n\nContents \n\n1 History \n2 Construction \n3 Types \n\n3.1 Vaginal use \n3.2 Rectal use \n3.3 Nasal use \n3.4 Aural use \n3.5 Oral use \n\n\n4 BDSM \n5 See also \n6 References \n\n\nHistory \n 14th, 15th and 16th century specula\nVaginal and anal specula were used by the ancient Greeks and Romans,[2] and speculum artifacts have been found in Pompeii.[3] A vaginal speculum, developed by J. Marion Sims, consists of a hollow cylinder with a rounded end that is divided into two hinged parts, somewhat like the beak of a duck. The speculum is inserted into the vagina to dilate it for examination of the vagina and cervix.\n\nConstruction \nSpecula were formerly made of stainless steel, and sterilized after use. However, many, especially those used in emergency departments and doctor's offices, are now made of plastic, and are disposable, single-use items. Those used in surgical suites are still commonly made of metal.\n\nTypes \n Two cylindrical-shaped glass specula\nSpecula come in a variety of shapes based on their purpose, and a variety of sizes;[4] in any case the cylinder or blade(s) of the instrument allow the operator a direct vision of the area of interest and the possibility to introduce instruments for further interventions such as a biopsy.\n\nVaginal use \nThe best-known speculum is the bivalved vaginal speculum; the two blades are hinged and are \"closed\" when the speculum is inserted to facilitate its entry and \"opened\" in its final position where they can be arrested by a screw mechanism, so that the operator is freed from keeping the blades apart.\n\nA cylindrical-shaped speculum, introduced in 2001, the dilating vaginal speculum (also known as the Veda-scope[5]) invented by Clemens van der Weegen,[6] inflates the vagina with filtered air.[7] (see diagram) The device has two main functions: a) to take a normal Pap smear with a cervical brush or a cytology brush; and b) as an internal colposcope so that the operator can pivot the Veda-scope to view any part of the vagina barrel and cervix facilitated by an internal light source that can illuminate the vaginal wall and cervix with multi-coloured light filters, which can detect pre-cancerous cells with the aid of acetic acid solution and iodine solution. It also has a facility to attach a digital camera for viewing and recording.[8] Dilating vaginal speculum inflating vagina and light illuminating (cervical brush inserts through top inlet)\nA specialized form of vaginal speculum is the weighted speculum, which consists of a broad half tube which is bent at about a 90 degree angle, with the channel of the tube on the exterior side of the angle. One end of the tube has a roughly spherical metal weight surrounding the channel of the speculum. A weighted speculum is placed in the vagina during vaginal surgery with the patient in the lithotomy position. The weight holds the speculum in place and frees the surgeon's hands for other tasks.\nA vaginal speculum is also used in fertility treatments, particularly artificial insemination, and allows the vaginal cavity to be opened and observed thereby facilitating the deposit of semen into the vagina.\n\nCylindrical shape\nFerguson\nGlass speculum\nVeda-scope (dilating vaginal speculum)\nOne blade\n The single-bladed Sims speculum is still in use today.\n\n\n\n\nAuvard\nBreisky\nDoyen\nEastman\nJackson\nKallmorgen\nKristeller\n\n\nLandau\nMartin\nMathieu\nPolansky\nSamuel\nScherbak\nSims\nWeissbarth\n\nTwo blades (bivalved)\n Medical instrument\n Duckbill shape of a two-bladed speculum\n\n\n\n\nCollin\nCusco\nDeVilbiss\nGrave\n\n\nPederson\nSemm\nSeyffert\nTrelat\nWinterton\n\nThree blades\n\n\n\n\nGuttmann\nNott\n\n\nO\u00b4Sullivan-O\u00b4Connor\nPolansky (veterinary use)\n\nRectal use \nVaginal specula are also used for anal surgery, although several other forms of anal specula exist. One form, the anoscope, resembles a tube that has a removable bullet-shaped insert. When the anoscope is inserted into the anus, the insert dilates the anus to the diameter of the tube. The insert is then removed, leaving the tube to allow examination of the lower rectum and anus.\nThis style of anal speculum is one of the oldest designs for surgical instruments still in use, with examples dating back many centuries. The sigmoidoscope can be further advanced into the lower intestinal tract and requires an endoscopic set-up.\n\nTubal shape\nAniscope\nOne blade\nCzerny\nTwo blades\n\n\n\n\nBarr\nBodenhammer\nKillian\nPratt\n\n\nRicord\nRoschke\nSims\nSmith-Buie\n\nThree blades\nAlan Park\nCook\nMathieu\nNasal use \nNasal specula have two relatively flat blades with handle. The instrument is hinged so that when the handles are squeezed together the blades spread laterally, allowing examination.\n\n\n\n\n\nKillian\nVienna\n\n\nVoltolini\nYankauer\n\nAdditionally, the Thudichum nasal speculum is commonly used in the outpatient examination of the nose.\n\nAural use \n Ear specula are funnel-shaped.\nEar or aural specula resemble a funnel, and come in a variety of sizes.\n\n\n\n\n\nAural speculum\n\n\n\nOral use \nIn veterinary medicine, a McPherson Speculum can be used for oral examination. The speculum helps keep the mouth open during the exam and helps avoid biting injuries.\n\nBDSM \nSpeculum is used for Speculum Play under BDSM for spreading the vagina or the anus.[9]\n\nSee also \n Endoscope\n Colposcope\n Vaginal dilator\nReferences \n\n\n\nWikimedia Commons has media related to speculums.\n\n\n^ \"diopter\" in The Compact Edition of the Oxford English Dictionary, Oxford University Press, 1971 \n\n^ Univ. of Virginia. \"Surgical Instruments from Ancient Rome (with pictures)\". Retrieved 2009-06-12 . \n\n^ Cecilia Mettler. History of Medicine. The Blakiston Co (1947). \n\n^ \"Comparison chart of speculum types, with line images\". Retrieved 2014-05-03 . \n\n^ Longmore, P. G. (2004). \"Veda-scope: More comfortable than the bivalve speculum and cytologically equivalent\". The Australian and New Zealand Journal of Obstetrics and Gynaecology. 44 (2): 140\u20135. doi:10.1111\/j.1479-828X.2004.00180.x. PMID 15089838. \n\n^ van der Weegen, Clemens (2000) \"Vaginal speculum with seal\" U.S. Patent 6,719,687 \n\n^ Thomas, A; Weisberg, E; Lieberman, D; Fraser, I. S. (2001). \"A randomised controlled trial comparing a dilating vaginal speculum with a conventional bivalve speculum\". The Australian & New Zealand journal of obstetrics & gynaecology. 41 (4): 379\u201386. PMID 11787909. \n\n^ How it works. pacificei.com \n\n^ Speculum Play by www.kinkly.com \n\n\nvteSurgical instrumentsDissectingScalpels\nLaser scalpel\nRF knife\nLancets\nListon knife\nCatlin\nVon Graefe knife\nSurgical scissors:\nBandage scissors\nIris scissors\nMayo scissors\nMetzenbaum scissors\nTenotomy scissors\nOther:\nRongeur\nCurette\nOsteotome\nDrill bits\nRasps\nTrocars\nDrills\nCranial drills\nDental drills\nDermatomes\nGrasping (forceps)\nBulldogs forceps\nHemostat\nObstetric\nVulsellum\nTenaculum\nDebakey forceps\nClamping\nFoerster clamp\nHemostat\nPennington clamp\nAortic cross-clamp\nGomco clamp\nAllis clamp\nRetracting\/viewing\nRetractors: Senn retractor\nRib spreader\nAccessory\/otherExamination\/prep:\nDilators\nSpecula\nFiber optic endoscopes\nHead mirror\nSuction:\nYankauer suction tip\n\nIrrigation and injection needles\nMeasurement devices:\nrulers and calipers\nDrain:\nJackson-Pratt drain\nPenrose drain\nOther:\nSurgical staplers\nPeriodontal probe\nSurgical suture\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Speculum_(medical)\">https:\/\/www.limswiki.org\/index.php\/Speculum_(medical)<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:54.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 742 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","3633b9ae4a7a31327d7d10b337925b43_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Speculum_medical skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Speculum (medical)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"shortdescription nomobile noexcerpt noprint searchaux\" style=\"display:none\">Medical device for investigating body orifices by direct vision<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:252px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sp%C3%A9culum_en_plastique.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/78\/Sp%C3%A9culum_en_plastique.jpg\/250px-Sp%C3%A9culum_en_plastique.jpg\" width=\"250\" height=\"184\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sp%C3%A9culum_en_plastique.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The disposable bivalved plastic vaginal speculum is used in office gynecology<\/div><\/div><\/div>\n<p>A <b>speculum<\/b> (Latin for \"mirror\"; plural <b>specula<\/b> or speculums) is a medical tool for investigating body <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orifices\" class=\"mw-redirect\" title=\"Orifices\" rel=\"external_link\" target=\"_blank\">orifices<\/a>, with a form dependent on the orifice for which it is designed. In old texts, the speculum may also be referred to as a <b>diopter<\/b> or <b>dioptra<\/b>.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup> Like an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\">endoscope<\/a>, a speculum allows a view inside the body; endoscopes, however, tend to have <a href=\"https:\/\/en.wikipedia.org\/wiki\/Optics\" title=\"Optics\" rel=\"external_link\" target=\"_blank\">optics<\/a> while a speculum is intended for direct vision.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:5_Speculum,_14th_15th_and_16th_century._Wellcome_M0008374.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/54\/5_Speculum%2C_14th_15th_and_16th_century._Wellcome_M0008374.jpg\/220px-5_Speculum%2C_14th_15th_and_16th_century._Wellcome_M0008374.jpg\" width=\"220\" height=\"172\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:5_Speculum,_14th_15th_and_16th_century._Wellcome_M0008374.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>14th, 15th and 16th century specula<\/div><\/div><\/div>\n<p>Vaginal and anal specula were used by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Greece\" title=\"Ancient Greece\" rel=\"external_link\" target=\"_blank\">ancient Greeks<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Rome\" title=\"Ancient Rome\" rel=\"external_link\" target=\"_blank\">Romans<\/a>,<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> and speculum <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artifact_(archaeology)\" title=\"Artifact (archaeology)\" rel=\"external_link\" target=\"_blank\">artifacts<\/a> have been found in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pompeii\" title=\"Pompeii\" rel=\"external_link\" target=\"_blank\">Pompeii<\/a>.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup> A vaginal speculum, developed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/J._Marion_Sims\" title=\"J. Marion Sims\" rel=\"external_link\" target=\"_blank\">J. Marion Sims<\/a>, consists of a hollow cylinder with a rounded end that is divided into two hinged parts, somewhat like the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Beak\" title=\"Beak\" rel=\"external_link\" target=\"_blank\">beak<\/a> of a duck. The speculum is inserted into the vagina to dilate it for examination of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vagina\" title=\"Vagina\" rel=\"external_link\" target=\"_blank\">vagina<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cervix\" title=\"Cervix\" rel=\"external_link\" target=\"_blank\">cervix<\/a>.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Construction\">Construction<\/span><\/h2>\n<p>Specula were formerly made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a>, and sterilized after use. However, many, especially those used in emergency departments and doctor's offices, are now made of plastic, and are disposable, single-use items. Those used in surgical suites are still commonly made of metal.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Glasspekula.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c2\/Glasspekula.jpg\/170px-Glasspekula.jpg\" width=\"170\" height=\"226\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Glasspekula.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Two cylindrical-shaped glass specula<\/div><\/div><\/div>\n<p>Specula come in a variety of shapes based on their purpose, and a variety of sizes;<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup> in any case the cylinder or blade(s) of the instrument allow the operator a direct vision of the area of interest and the possibility to introduce instruments for further interventions such as a biopsy.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Vaginal_use\">Vaginal use<\/span><\/h3>\n<p>The best-known speculum is the bivalved vaginal speculum; the two blades are hinged and are \"closed\" when the speculum is inserted to facilitate its entry and \"opened\" in its final position where they can be arrested by a screw mechanism, so that the operator is freed from keeping the blades apart.\n<\/p><p>\nA cylindrical-shaped speculum, introduced in 2001, the dilating vaginal speculum (also known as the Veda-scope<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>) invented by Clemens van der Weegen,<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup> inflates the vagina with filtered air.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup> (see diagram) The device has two main functions: a) to take a normal Pap smear with a cervical brush or a cytology brush; and b) as an internal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Colposcope\" class=\"mw-redirect\" title=\"Colposcope\" rel=\"external_link\" target=\"_blank\">colposcope<\/a> so that the operator can pivot the Veda-scope to view any part of the vagina barrel and cervix facilitated by an internal light source that can illuminate the vaginal wall and cervix with multi-coloured light filters, which can detect pre-cancerous cells with the aid of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Acetic_acid\" title=\"Acetic acid\" rel=\"external_link\" target=\"_blank\">acetic acid<\/a> solution and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Iodine\" title=\"Iodine\" rel=\"external_link\" target=\"_blank\">iodine<\/a> solution. It also has a facility to attach a digital camera for viewing and recording.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup> <\/p><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:200px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dilating_vaginal_speculum_inflating_vagina_and_light_illuminating.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/b\/b7\/Dilating_vaginal_speculum_inflating_vagina_and_light_illuminating.jpg\" width=\"198\" height=\"132\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dilating_vaginal_speculum_inflating_vagina_and_light_illuminating.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Dilating vaginal speculum inflating vagina and light illuminating (cervical brush inserts through top inlet)<\/div><\/div><\/div>\n<p>A specialized form of vaginal speculum is the weighted speculum, which consists of a broad half tube which is bent at about a 90 degree angle, with the channel of the tube on the exterior side of the angle. One end of the tube has a roughly spherical metal weight surrounding the channel of the speculum. A weighted speculum is placed in the vagina during vaginal <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a> with the patient in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lithotomy_position\" title=\"Lithotomy position\" rel=\"external_link\" target=\"_blank\">lithotomy position<\/a>. The weight holds the speculum in place and frees the surgeon's hands for other tasks.\nA vaginal speculum is also used in fertility treatments, particularly artificial insemination, and allows the vaginal cavity to be opened and observed thereby facilitating the deposit of semen into the vagina.\n<\/p>\n<dl><dt>Cylindrical shape<\/dt><\/dl>\n<ul><li>Ferguson<\/li>\n<li>Glass speculum<\/li>\n<li>Veda-scope (dilating vaginal speculum)<\/li><\/ul>\n<dl><dt>One blade<\/dt><\/dl>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sims.Speculum.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/95\/Sims.Speculum.jpg\/170px-Sims.Speculum.jpg\" width=\"170\" height=\"220\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Sims.Speculum.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>The single-bladed Sims speculum is still in use today.<\/div><\/div><\/div>\n<table style=\"\">\n\n<tbody><tr>\n<td valign=\"top\">\n<ul><li>Auvard<\/li>\n<li>Breisky<\/li>\n<li>Doyen<\/li>\n<li>Eastman<\/li>\n<li>Jackson<\/li>\n<li>Kallmorgen<\/li>\n<li>Kristeller<\/li><\/ul>\n<\/td>\n<td valign=\"top\">\n<ul><li>Landau<\/li>\n<li>Martin<\/li>\n<li>Mathieu<\/li>\n<li>Polansky<\/li>\n<li>Samuel<\/li>\n<li>Scherbak<\/li>\n<li>Sims<\/li>\n<li>Weissbarth<\/li><\/ul>\n<\/td><\/tr><\/tbody><\/table>\n<dl><dt>Two blades (bivalved)<\/dt><\/dl>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Speculum_of_Polansky.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/24\/Speculum_of_Polansky.jpg\/220px-Speculum_of_Polansky.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Speculum_of_Polansky.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Medical instrument<\/div><\/div><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Speculum_en_m%C3%A9tal.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5c\/Speculum_en_m%C3%A9tal.jpg\/170px-Speculum_en_m%C3%A9tal.jpg\" width=\"170\" height=\"213\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Speculum_en_m%C3%A9tal.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Duckbill shape of a two-bladed speculum<\/div><\/div><\/div>\n<table style=\"\">\n\n<tbody><tr>\n<td valign=\"top\">\n<ul><li>Collin<\/li>\n<li>Cusco<\/li>\n<li>DeVilbiss<\/li>\n<li>Grave<\/li><\/ul>\n<\/td>\n<td valign=\"top\">\n<ul><li>Pederson<\/li>\n<li>Semm<\/li>\n<li>Seyffert<\/li>\n<li>Trelat<\/li>\n<li>Winterton<\/li><\/ul>\n<\/td><\/tr><\/tbody><\/table>\n<dl><dt>Three blades<\/dt><\/dl>\n<table style=\"\">\n\n<tbody><tr>\n<td valign=\"top\">\n<ul><li>Guttmann<\/li>\n<li>Nott<\/li><\/ul>\n<\/td>\n<td valign=\"top\">\n<ul><li>O\u00b4Sullivan-O\u00b4Connor<\/li>\n<li>Polansky (veterinary use)<\/li><\/ul>\n<\/td><\/tr><\/tbody><\/table>\n<h3><span class=\"mw-headline\" id=\"Rectal_use\">Rectal use<\/span><\/h3>\n<p>Vaginal specula are also used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anus\" title=\"Anus\" rel=\"external_link\" target=\"_blank\">anal<\/a> surgery, although several other forms of anal specula exist. One form, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anoscopy\" title=\"Anoscopy\" rel=\"external_link\" target=\"_blank\">anoscope<\/a>, resembles a tube that has a removable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bullet\" title=\"Bullet\" rel=\"external_link\" target=\"_blank\">bullet<\/a>-shaped insert. When the anoscope is inserted into the anus, the insert dilates the anus to the diameter of the tube. The insert is then removed, leaving the tube to allow examination of the lower rectum and anus.\n<\/p><p>This style of anal speculum is one of the oldest designs for surgical instruments still in use, with examples dating back many centuries. The <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sigmoidoscopy\" title=\"Sigmoidoscopy\" rel=\"external_link\" target=\"_blank\">sigmoidoscope<\/a> can be further advanced into the lower intestinal tract and requires an endoscopic set-up.\n<\/p>\n<dl><dt>Tubal shape<\/dt><\/dl>\n<ul><li>Aniscope<\/li><\/ul>\n<dl><dt>One blade<\/dt><\/dl>\n<ul><li>Czerny<\/li><\/ul>\n<dl><dt>Two blades<\/dt><\/dl>\n<table style=\"\">\n\n<tbody><tr>\n<td valign=\"top\">\n<ul><li>Barr<\/li>\n<li>Bodenhammer<\/li>\n<li>Killian<\/li>\n<li>Pratt<\/li><\/ul>\n<\/td>\n<td valign=\"top\">\n<ul><li>Ricord<\/li>\n<li>Roschke<\/li>\n<li>Sims<\/li>\n<li>Smith-Buie<\/li><\/ul>\n<\/td><\/tr><\/tbody><\/table>\n<dl><dt>Three blades<\/dt><\/dl>\n<ul><li>Alan Park<\/li>\n<li>Cook<\/li>\n<li>Mathieu<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Nasal_use\">Nasal use<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Human_nose\" title=\"Human nose\" rel=\"external_link\" target=\"_blank\">Nasal<\/a> specula have two relatively flat blades with handle. The instrument is hinged so that when the handles are squeezed together the blades spread laterally, allowing examination.\n<\/p>\n<table style=\"\">\n\n<tbody><tr>\n<td valign=\"top\">\n<ul><li>Killian<\/li>\n<li>Vienna<\/li><\/ul>\n<\/td>\n<td valign=\"top\">\n<ul><li>Voltolini<\/li>\n<li>Yankauer<\/li><\/ul>\n<\/td><\/tr><\/tbody><\/table>\n<p>Additionally, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Johann_Ludwig_Wilhelm_Thudichum\" title=\"Johann Ludwig Wilhelm Thudichum\" rel=\"external_link\" target=\"_blank\">Thudichum<\/a> nasal speculum is commonly used in the outpatient examination of the nose.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Aural_use\">Aural use<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Aural_Speculum_ENT_Instrument_Medical.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/11\/Aural_Speculum_ENT_Instrument_Medical.jpg\/220px-Aural_Speculum_ENT_Instrument_Medical.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Aural_Speculum_ENT_Instrument_Medical.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Ear specula are funnel-shaped.<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ear\" title=\"Ear\" rel=\"external_link\" target=\"_blank\">Ear<\/a> or aural specula resemble a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Funnel\" title=\"Funnel\" rel=\"external_link\" target=\"_blank\">funnel<\/a>, and come in a variety of sizes.\n<\/p>\n<table style=\"\">\n\n<tbody><tr>\n<td valign=\"top\">\n<ul><li>Aural speculum<\/li><\/ul>\n<\/td>\n<td valign=\"top\">\n<\/td><\/tr><\/tbody><\/table>\n<h3><span class=\"mw-headline\" id=\"Oral_use\">Oral use<\/span><\/h3>\n<p>In veterinary medicine, a McPherson Speculum can be used for oral examination. The speculum helps keep the mouth open during the exam and helps avoid biting injuries.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"BDSM\">BDSM<\/span><\/h2>\n<p>Speculum is used for <i>Speculum Play<\/i> under <a href=\"https:\/\/en.wikipedia.org\/wiki\/BDSM\" title=\"BDSM\" rel=\"external_link\" target=\"_blank\">BDSM<\/a> for spreading the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vagina\" title=\"Vagina\" rel=\"external_link\" target=\"_blank\">vagina<\/a> or the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Anus\" title=\"Anus\" rel=\"external_link\" target=\"_blank\">anus<\/a>.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Endoscope\" title=\"Endoscope\" rel=\"external_link\" target=\"_blank\"> Endoscope<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Colposcopy\" title=\"Colposcopy\" rel=\"external_link\" target=\"_blank\"> Colposcope<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vaginal_dilator\" title=\"Vaginal dilator\" rel=\"external_link\" target=\"_blank\"> Vaginal dilator<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"diopter\" in <i>The Compact Edition of the Oxford English Dictionary<\/i>, Oxford University Press, 1971<\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Univ. of Virginia. <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hsl.virginia.edu\/historical\/artifacts\/roman_surgical\/\" target=\"_blank\">\"Surgical Instruments from Ancient Rome (with pictures)\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2009-06-12<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Surgical+Instruments+from+Ancient+Rome++%28with+pictures%29&rft.au=Univ.+of+Virginia&rft_id=http%3A%2F%2Fwww.hsl.virginia.edu%2Fhistorical%2Fartifacts%2Froman_surgical%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpeculum+%28medical%29\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cecilia_Mettler\" title=\"Cecilia Mettler\" rel=\"external_link\" target=\"_blank\">Cecilia Mettler<\/a>. <i>History of Medicine<\/i>. The Blakiston Co (1947).<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=History+of+Medicine&rft.pub=The+Blakiston+Co+%281947%29&rft.au=Cecilia+Mettler&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpeculum+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.m-e-dical.com\/english\/vs.htm\" target=\"_blank\">\"Comparison chart of speculum types, with line images\"<\/a><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2014-05-03<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Comparison+chart+of+speculum+types%2C+with+line+images&rft_id=http%3A%2F%2Fwww.m-e-dical.com%2Fenglish%2Fvs.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpeculum+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Longmore, P. G. (2004). \"Veda-scope: More comfortable than the bivalve speculum and cytologically equivalent\". <i>The Australian and New Zealand Journal of Obstetrics and Gynaecology<\/i>. <b>44<\/b> (2): 140\u20135. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1111%2Fj.1479-828X.2004.00180.x\" target=\"_blank\">10.1111\/j.1479-828X.2004.00180.x<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15089838\" target=\"_blank\">15089838<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Australian+and+New+Zealand+Journal+of+Obstetrics+and+Gynaecology&rft.atitle=Veda-scope%3A+More+comfortable+than+the+bivalve+speculum+and+cytologically+equivalent&rft.volume=44&rft.issue=2&rft.pages=140-5&rft.date=2004&rft_id=info%3Adoi%2F10.1111%2Fj.1479-828X.2004.00180.x&rft_id=info%3Apmid%2F15089838&rft.aulast=Longmore&rft.aufirst=P.+G.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpeculum+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">van der Weegen, Clemens (2000) \"Vaginal speculum with seal\" <span><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.google.com\/patents\/US6719687\" target=\"_blank\">U.S. Patent 6,719,687<\/a><\/span><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Thomas, A; Weisberg, E; Lieberman, D; Fraser, I. S. (2001). \"A randomised controlled trial comparing a dilating vaginal speculum with a conventional bivalve speculum\". <i>The Australian & New Zealand journal of obstetrics & gynaecology<\/i>. <b>41<\/b> (4): 379\u201386. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11787909\" target=\"_blank\">11787909<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Australian+%26+New+Zealand+journal+of+obstetrics+%26+gynaecology&rft.atitle=A+randomised+controlled+trial+comparing+a+dilating+vaginal+speculum+with+a+conventional+bivalve+speculum&rft.volume=41&rft.issue=4&rft.pages=379-86&rft.date=2001&rft_id=info%3Apmid%2F11787909&rft.aulast=Thomas&rft.aufirst=A&rft.au=Weisberg%2C+E&rft.au=Lieberman%2C+D&rft.au=Fraser%2C+I.+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASpeculum+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/pacificei.com\/how_work.html\" target=\"_blank\">How it works<\/a>. pacificei.com<\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.kinkly.com\/definition\/14516\/speculum-play\" target=\"_blank\">Speculum Play by www.kinkly.com<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1275\nCached time: 20181207063749\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.280 seconds\nReal time usage: 0.398 seconds\nPreprocessor visited node count: 792\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 35336\/2097152 bytes\nTemplate argument size: 615\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 14407\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.145\/10.000 seconds\nLua memory usage: 4.01 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 321.208 1 -total\n<\/p>\n<pre>43.36% 139.267 1 Template:Reflist\n22.05% 70.834 1 Template:Commons_category\n20.48% 65.770 2 Template:Cite_web\n15.42% 49.546 1 Template:Short_description\n14.31% 45.974 1 Template:Pagetype\n13.39% 43.017 2 Template:Cite_journal\n 9.92% 31.878 3 Template:Annotated_link\n 8.17% 26.238 6 Template:Template_parameter_value\n 6.76% 21.706 3 Template:Navbox\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:320320-1!canonical and timestamp 20181207063749 and revision id 867410457\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Speculum_%28medical%29\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214655\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.160 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 153.088 1 - wikipedia:Speculum_(medical)\n100.00% 153.088 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8558-0!*!*!*!*!*!* and timestamp 20181217214655 and revision id 24986\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Speculum_(medical)\">https:\/\/www.limswiki.org\/index.php\/Speculum_(medical)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","3633b9ae4a7a31327d7d10b337925b43_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/78\/Sp%C3%A9culum_en_plastique.jpg\/500px-Sp%C3%A9culum_en_plastique.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/54\/5_Speculum%2C_14th_15th_and_16th_century._Wellcome_M0008374.jpg\/440px-5_Speculum%2C_14th_15th_and_16th_century._Wellcome_M0008374.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c2\/Glasspekula.jpg\/340px-Glasspekula.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/b\/b7\/Dilating_vaginal_speculum_inflating_vagina_and_light_illuminating.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/95\/Sims.Speculum.jpg\/340px-Sims.Speculum.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/24\/Speculum_of_Polansky.jpg\/440px-Speculum_of_Polansky.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5c\/Speculum_en_m%C3%A9tal.jpg\/340px-Speculum_en_m%C3%A9tal.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/11\/Aural_Speculum_ENT_Instrument_Medical.jpg\/440px-Aural_Speculum_ENT_Instrument_Medical.jpg"],"3633b9ae4a7a31327d7d10b337925b43_timestamp":1545083215,"739645b065bcad0f5a9e9e65c6d95099_type":"article","739645b065bcad0f5a9e9e65c6d95099_title":"Scalpel","739645b065bcad0f5a9e9e65c6d95099_url":"https:\/\/www.limswiki.org\/index.php\/Scalpel","739645b065bcad0f5a9e9e65c6d95099_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tScalpel\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor other uses, see Scalpel (disambiguation).\nThis article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (January 2008) (Learn how and when to remove this template message)\nScalpelVarious scalpels. The first (from left), second, and fourth have replaceable bladesClassificationCutting toolUsed withStencil, surgeryRelatedLancet, utility knife, laser scalpel\nA scalpel, or lancet, is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, podiatry and various arts and crafts (called a hobby knife). Scalpels may be single-use disposable or re-usable. Re-usable scalpels can have permanently attached blades that can be sharpened or, more commonly, removable single-use blades. Disposable scalpels usually have a plastic handle with an extensible blade (like a utility knife) and are used once, then the entire instrument is discarded. Scalpel blades are usually individually packed in sterile pouches but are also offered non-sterile. Double-edged scalpels are referred to as \"lancets\".\nScalpel blades are usually made of hardened and tempered steel, stainless steel, or high carbon steel; in addition, titanium, ceramic, diamond and even obsidian knives are not uncommon. For example, when performing surgery under MRI guidance, steel blades are unusable (the blades would be drawn to the magnets, or may cause image artifacts). Historically, the preferred material for surgical scalpels was silver. Scalpel blades are also offered by select manufacturers with a zirconium nitride-coated edge to improve sharpness and edge retention. Others manufacture blades that are polymer-coated to enhance lubricity during a cut. Alternatives to scalpels in surgical applications include electrocautery and lasers.\n\nContents \n\n1 Surgical scalpels \n\n1.1 Gripping a medical scalpel \n\n1.1.1 Palmar grip \n1.1.2 Pencil grip \n\n\n\n\n2 Graphic design and arts and crafts blades \n3 Ancient scalpels \n4 Scalpel injuries \n\n4.1 Safety scalpels \n4.2 Blade removers \n4.3 Safety \n\n\n5 See also \n6 References \n7 External links \n\n\nSurgical scalpels \nReusable handle (top) and disposable scalpels (bottom)\nSurgical scalpels consist of two parts, a blade and a handle. The handles are often reusable, with the blades being replaceable. In medical applications, each blade is only used once (even if just for a single, small cut).\nThe handle is also known as a \"B.P. handle\", named after Charles Russell Bard and Morgan Parker, founders of the Bard-Parker Company. Morgan Parker patented the 2-piece scalpel design in 1915 and Bard-Parker developed a method of cold sterilization that would not dull the blades, as did the heat-based method that was previously used.[1]\nThe handle of medical scalpels come in two basic types. The first is a flat handle used in the #3 and #4 handles. The #7 handle is more like a long writing pen, rounded at the front and flat at the back. A #4 handle is larger than a #3. Blades are manufactured with a corresponding fitment size so that they fit on only one size handle. The following table of blades is incomplete and some blades listed may work with handles not specified here.\n\n\nTypes of surgical scalpel blades\n\n\nBlade No.\nPicture\nCompatible Handles\nBlade Description\nUses\n\n\nNo. 6\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. 9\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. 10\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nCurved cutting edge with an unsharpened back edge. A more traditional blade shape.\nGenerally for making incisions in skin and muscle. Commonly used to cut the skin in abdominal operations.\n\n\nNo. 10a\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nThis blade is a small and straight\n\n\n\nNo. 11\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nTriangular blade with sharp point, flat cutting edge parallel to the handle and flat back\nFor precision cutting, stripping, sharp angle cuts and also stencil cutting due to its similarity to the X-Acto artknife blade\n\n\nNo. 11P\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. E11\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. E\/11\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\nDebriding hard skin for example callus by Podiatrists.\n\n\nNo. 12\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nA small, pointed, crescent-shaped blade sharpened on the inside edge of the curve\n\n\n\nNo. 12D\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nA small, pointed, crescent-shaped blade sharpened on both sides of the curve\n\n\n\nNo. 13\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. 14\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. 15\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nA smaller version of the #10\nFor the same general use as the #10 blade\n\n\nNo. 15A\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nA front-facing straight blade with flat back\n\n\n\nNo. 15C\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nThe #15 with a downward angle, flatter and thinner than the #15\nThe downward angle makes this the preferred blade for working within the chest during cardiac surgery, and is commonly used to make the distal arteriotomy during coronary artery bypass grafting.\n\n\nNo. 15T\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\nEnucleation of lesions such as corns.\n\n\nNo. D\/15\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. 16\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nA narrow chisel-like blade with flat, angled cutting edge, positioned higher than the axis of the handle\nFor cutting stencils, scoring and etching\n\n\nNo. 17\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\nA flat face 1.6 mm chisel blade\nFor narrow cuts\n\n\nNo. 18\n\n4, 4 Graduated, 4 Long, 6\nA 12.7 mm chisel blade\nFor deep cuts and scraping\n\n\nNo. 19\n\n4, 4 Graduated, 4 Long, 6\nA similar blade to the #15\n\n\n\nNo. 20\n\n4, 4 Graduated, 4 Long, 6\nA larger version of the #10 blade, with a curved cutting edge and a flat, unsharpened back edge.\nUsed in general surgery and orthopaedic surgery.\n\n\nNo. 21\n\n4, 4 Graduated, 4 Long, 6\n\n\n\n\nNo. 22\n\n2, 4, 5, 6\nA slightly larger version of the #20, with a curved cutting edge and a flat, unsharpened back edge.\nUsed for skin incisions in both cardiac and thoracic surgery, and to cut the bronchus in lung resection surgery.\n\n\nNo. 22A\n\n4, 4 Graduated, 4 Long, 6\n\n\n\n\nNo. 23\n\n4, 4 Graduated, 4 Long, 6\nSimilar to #22, leaf-shaped\nFor long incisions.\n\n\nNo. 24\n\n4, 4 Graduated, 4 Long, 6\nA wide, flat, angled cutting edge\nFor corner cuts, trimming, stripping, and cutting mats and gaskets\n\n\nNo. 25\n\n4, 4 Graduated, 4 Long, 6\nA front-facing straight blade with flat back (similar to #15a)\n\n\n\nNo. 25a\n\n4, 4 Graduated, 4 Long, 6\nA triangular straight blade with flat back edge taking a downwards angle (similar to #10a, shorter than #26)\n\n\n\nNo. 26\n\n4, 4 Graduated, 4 Long, 6\nA triangular straight blade with flat back edge taking a downwards angle (similar to the #15a, longer than #25a)\n\n\n\nNo. 27\n\n4, 4 Graduated, 4 Long, 6\n\n\n\n\nNo. 34\n\n4, 4 Graduated, 4 Long, 6\nA triangular blade similar to the #11\n\n\n\nNo. 36\n\n4, 4 Graduated, 4 Long, 6\nA larger blade\nUsed in general surgery but also within a Laboratory setting for Histology and Histopathology\n\n\nNo. 40\n\nB3, 3, 3 Graduated, 3 Long, 5, 7, 9\n\n\n\n\nNo. PM40\n\nStainless PM Handle\n\n\n\n\nNo. PM40B\n\nStainless PM Handle\n\n\n\n\nNo. 60\n\n4, 4 Graduated, 4 Long, 6\nA long blade resembling the #10 with a long cutting edge, rounded tip and flat back.\n\n\n\nNo. PM60\n\nPM8\n\n\n\n\nNo. PM60B\n\nPM8\n\n\n\nGripping a medical scalpel \n Palmar grip\nPalmar grip \nAlso called the \"dinner knife\" grip. The handle is held with the second through fourth fingers and secured along the base of the thumb, with the index finger extended along the top rear of the blade and the thumb along the side of the handle. This grip is best for initial incisions and larger cuts.\n\nPencil grip \n Pencil grip\nBest used for more accurate cuts with smaller blades (e.g. #15) and the #7 handle. The scalpel is held with the tips of the first and second fingers and the tip of the thumb with the handle resting on the fleshy base of the index finger and thumb. Care should be taken not to allow the handle to rest too far along the index finger as this promotes an unstable grip and cramped fingers.\n\nGraphic design and arts and crafts blades \n X-Acto knife\nGraphical and model-making scalpels tend to have round handles, with textured grips (either knurled metal or soft plastic). The blade is usually flat and straight, allowing it to be run easily against a straightedge to produce straight cuts.\nThere are many kinds of graphic arts blades; the most common around the graphic design studio is the #11 blade which is very similar to a #11 surgical blade (q.v.). Other blade shapes are used for wood carving, cutting leather and heavy fabric, etc.\n\nAncient scalpels \nObsidian scalpels older than 2100 BC have been found in a Bronze Age settlement in Turkey.[2] Skulls from the same time and place show signs of brain surgery.[3]\nAncient Egyptians made incisions for embalming with scalpels of sharpened obsidian, a material that is still in use.\nThe first medical writings of ancient Greeks indicate they were commonly using tools identical to today's scalpels around 500 BC.[4]\nAncient Romans used more than 150 different surgical instruments, including scalpels.[5]\nIndian Ayurvedic medicine mentions the use of sharp bamboo splinters.[citation needed ]\nScalpel injuries \nSee also: Needlestick injury\nIn the last decade,[when? ] a rising awareness of the dangers of sharps in a medical environment has led to the development of various methods of protecting healthcare workers from accidental cuts and puncture wounds. According to the Centers for Disease Control and Prevention, as many as 1,000 people each day are subject to accidental needle sticks and lacerations while providing medical care. Scalpel blade injuries are among the most frequent sharps injuries, second only to needlesticks. Scalpel injuries make up 7 percent to 8 percent of all sharps injuries.[6][7]\n\"Scalpel Safety\" is a term coined to inform users that there are choices available to them to ensure their protection from this common sharps injury.[8]\n\nSafety scalpels \nSafety scalpels are becoming increasingly popular as their prices come down and also on account of legislation such as the Needle Stick Prevention Act.[clarification needed ]\nThere are essentially two kinds of disposable safety scalpels offered by various manufacturers. They can be either classified as retractable blade or retractable sheath type. The retractable blade version made by companies such as OX Med Tech, DeRoyal, Jai Surgicals, Swann Morton, and PenBlade are more intuitive to use due to their similarities to a standard box-cutter. Retractable sheath versions have much stronger ergonomic feel for the doctors and are made by companies such as Aditya Dispomed, Aspen Surgical and Southmedic.\nA few companies[who? ] have also started to offer a safety scalpel with a reusable metal handle. In such models, the blade is usually protected in a cartridge. Such systems usually require a custom handle and the price of blades and cartridges is considerably more than for conventional surgical blades.\nHowever, CDC studies shows that up to 87% of active medical devices are not activated.[clarification needed ] Safety scalpels are active devices and therefore the risk of not activating is still significant.[9] There is a study that indicated there were actually four times more injuries with safety scalpels than reusable scalpels.[10][full citation needed ]\n\nBlade removers \nThere are various scalpel blade removers on the market that allows users to safely remove blades from the handle, instead of dangerously using fingers or forceps. In the medical field, when taking into account activation rates, the combination of a single-handed scalpel blade remover with a passing tray or a neutral zone was as safe and up to five times safer than a safety scalpel.[11] Companies like Qlicksmart offers a single-handed scalpel blade remover that complies with regulatory requirements such as US Occupational Safety and Health Administration Standards.[12]\n\nSafety \nThe usage of both safety scalpels and a single-handed blade remover, combined with a hands-free passing technique, are potentially effective in reducing scalpel blade injuries.[11] It is up to employers and scalpel users to consider and use safer and more effective scalpel safety measures when feasible.\n\nSee also \nLaser scalpel\nMedical device\nThe Lancet\nReferences \n\n\n^ Ochsner, J (2009). \"Surgical knife\". Texas Heart Institute Journal. 36 (5): 441\u2013443. PMC 2763477 . PMID 19876423. \n\n^ Jo Marchant. \"Scalpels and skulls point to Bronze Age brain surgery\". New Scientist. \n\n^ \"ARTS-CULTURE \u2013 Excavations restarting at \u0130kiztepe in northern Turkey\". \n\n^ Ochsner J (2009). \"Surgical Knife\". Tex Heart Inst J. 36 (5): 441\u20133. PMC 2763477 . PMID 19876423. \n\n^ \"Roman ruins cast new light on a trip to doctor\". Telegraph.co.uk. December 9, 2007. \n\n^ Perry J, Parker G, Jagger J (2003). \"EPINet Report: 2001 Percutaneous Injury Rates\". Advances in Exposure Prevention. 6 (3): 32\u201336. \n\n^ \"Sharps Injury Prevention Workbook\". Cdc.gov (Centre for Disease Control and Prevention). \n\n^ Sinnott M.; Wall D. (2007). \"' SCALPEL SAFETY': How safe (or dangerous) are safety scalpels?\". International Journal of Surgery. 6 (2): 176\u2013177. doi:10.1016\/j.ijsu.2007.01.010. \n\n^ Alvarado-Ramy F, Beltrami EM, Short LJ, et al. (2003). \"A comprehensive approach to percutaneous injury prevention during phlebotomy: results of a multicentre study, 1993\u20131995\". Infect Control Hosp Epidemiol. 24 (2): 97\u2013104. \n\n^ \"Needlestick and Sharp-Object Injury Report. US EPINet Network\". Advances in Exposure Prevention. 7 (4): 44\u201345. 2005. \n\n^ a b Fuentes, H., et al. (2008). \"Scalpel Safety\": Modeling the effectiveness of different safety devices' ability to reduce scalpel blade injuries.\" The International Journal of Risk & Safety in Medicine 20(1\u20132):83\u201389. \n\n^ \"OSHA Standard Interpretations \u2013 Use of passing trays and single-handed scalpel blade remover in a surgical setting\". Osha.gov. December 22, 2005. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Scalpels.\nvteCutting and abrasive tools\nAbrasive saw\nAxe\nBlade\nBandsaw\nBolt cutter\nBroach\nCeramic tile cutter\nChainsaw\nCircular saw\nChisel\nCoping saw\nCountersink\nCutting tool\nDiagonal pliers\nDiamond blade\nDiamond tool\nDrawknife\nDrill bit\nEmery cloth\nFile\nFretsaw\nFroe\nGlass cutter\nGrater\nGrinding wheel\nHacksaw\nHand saw\nHole saw\nIncisor\nKnife\nLaser\nLawn mower\nMachete\nMeat slicer\nMezzaluna\nMilling cutter\nMiter saw\nNail clipper\nNibbler\nPencil sharpener\nPipecutter\nPizza cutter\nPlasma cutter\nPlane\nPocket knife\nRasp\nRazor\nReamer\nSandpaper\nSaw\nScalpel\nScissors\nSnips\nSteel wool\nSurform\nSwitchblade\nTool bit\nUtility knife\nWater jet cutter\nWire brush\nWire stripper\n\nTypes of tools\nCleaning\nCutting and abrasive\nForestry\nGarden\nHand\nMachine and metalworking\nMeasuring and alignment\nPower\n\nvteKnives and daggers\nList of daggers\nList of blade materials\nTypes of knives\nAircrew Survival Egress Knife\nAthame\nBalisong\/Butterfly\nBallistic\nBallpoint pen knife\nBayonet\nBoline\nBolo\nBoning\nBoot knife\nBowie\nBread knife\nCane knife\nCheese knife\nChef's knife\nCleaver\nClip point\nCombat knife\nCommander\nCorvo\nCQC-6\nDeba b\u014dch\u014d\nDiving knife\nDrop point\nElectric knife\nFairbairn\u2013Sykes fighting knife\nGerber Mark II\nGinsu\nGrapefruit knife\nGravity knife\nGunong\nHunting knife\nJacob's ladder\nKarambit\nKard\nK\u012bla\nKirpan\nKitchen knife\nKukri\nLaguiole knife\nMachete\nMandau\nMezzaluna\nMisericorde\nMora knife\nMulti-tool\nNakiri b\u014dch\u014d\nNavaja\nNeck knife\nNontron knife\nOpinel knife\nPalette knife\nPantographic knife\nParang\nPenknife\nPenny knife\nPocket knife\nPutty knife\nPuukko\nRampuri\nResolza\nSabatier\nSami knife\nSantoku\nSARK\nScalpel\nSeax\nSgian dubh\nSharpfinger\nShiv\nSliding knife\nSmatchet\nSOG Knife\nStraight razor\nStrider SMF\nSurvival knife\nSwiss Army knife\nSwitchblade\nTaping knife\nThrowing knife\nTomato knife\nTrench knife\nTsakat\nTumi\nUlu\nUtility knife\nWarrior knife\nX-Acto\nYanagi ba\nYatagan\nTypes of daggers\nAnelace\nApplegate\u2013Fairbairn fighting knife\nArkansas toothpick\nBC-41\nBagh naka\nBaselard\nBichuwa\nBollock dagger\nCinquedea\nDirk\nEar dagger\nEmeici\nFac\u00f3n\nFrench Nail\nHachiwara\nHunting dagger\nJanbiya\nKaiken\nKalis\nKatar\nKhanjali\nKhanjar\nKris\nKunai\nMark I trench knife\nOcean Edge Knife\nParrying dagger\nPoignard\nQolxad\/Jile dagger\nPush dagger\nRondel dagger\nSeme\nShobo\nSica\nStiletto\nTant\u014d\nMarine Raider stiletto\nV-42 stiletto\nYarar\u00e1 Parachute Knife\nYoroid\u014dshi\nKnife manufacturers\nAitor\nAl Mar Knives\nAmerican Tomahawk Company\nBear MCG\nBenchmade\nB\u00f6ker\nBuck Knives\nCaber\nCamillus Cutlery Company\nCattaraugus Cutlery Company\nChris Reeve Knives\nCold Steel\nColumbia River Knife & Tool\nCuisinart\nCutco Cutlery\nDOVO Solingen\nDexter-Russell\nDirte Knives\nEikhorn\nEk Commando Knife Co.\nEmerson Knives\nErizo\nF. Dick\nF\u00e4llkniven\nFAMAE\nFiskars\nF\u00fcritechnics\nGerber Legendary Blades\nGlobal\nGolok\nHanwei\nImperial Schrade\nJ. A. Henckels\nKa-Bar\nKershaw Knives\nKitchenAid\nKorin Japanese Trading Company\nKyocera\nLeatherman\nMad Dog Knives\nMercWorx\nMicrotech Knives\nMorseth\nMurphy Knives\nOntario Knife Company\nOpinel\nRandall Made Knives\nRanz\nRigid Knives\nR\u00f6sle\nSOG Specialty Knives\nSabatier A\u00een\u00e9 & Perrier\nShun Cutlery\nSpyderco\nStrider Knives\nSurvival Aids\nTEKNA\nThiers Issard\nTramontina\nVictorinox\nVox Knives\nW. R. Case & Sons Cutlery Co.\nWalther arms\nWenger\nWestern Knife Company\nWilkinson Sword\nWindlass Steelcrafts\nW\u00fcsthof\nYarara Ltd\nZero Tolerance Knives\nKnifemakers\nA.G. Russell\nAmerican Bladesmith Society\nRex Applegate\nJames Black\nBlackie Collins\nJohn Nelson Cooper\nErnest Emerson\nJerry Fisk\nPhill Hartsfield\nBill Harsey Jr.\nGil Hibben\nKnifemakers' Guild\nZanjan Knifemakers\nJimmy Lile\nBob Loveless\nBob Lum\nWilliam F. 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Russell\nJody Samson\nWilliam Scagel\nMike Snody\nRobert Terzuola\nMichael Walker\nBuster Warenski\nDaniel Winkler\n\n Book:Knives and daggers\n Category:Knives \/ Daggers\n\nvteSurgical instrumentsDissectingScalpels\nLaser scalpel\nRF knife\nLancets\nListon knife\nCatlin\nVon Graefe knife\nSurgical scissors:\nBandage scissors\nIris scissors\nMayo scissors\nMetzenbaum scissors\nTenotomy scissors\nOther:\nRongeur\nCurette\nOsteotome\nDrill bits\nRasps\nTrocars\nDrills\nCranial drills\nDental drills\nDermatomes\nGrasping (forceps)\nBulldogs forceps\nHemostat\nObstetric\nVulsellum\nTenaculum\nDebakey forceps\nClamping\nFoerster clamp\nHemostat\nPennington clamp\nAortic cross-clamp\nGomco clamp\nAllis clamp\nRetracting\/viewing\nRetractors: Senn retractor\nRib spreader\nAccessory\/otherExamination\/prep:\nDilators\nSpecula\nFiber optic endoscopes\nHead mirror\nSuction:\nYankauer suction tip\n\nIrrigation and injection needles\nMeasurement devices:\nrulers and calipers\nDrain:\nJackson-Pratt drain\nPenrose drain\nOther:\nSurgical staplers\nPeriodontal probe\nSurgical suture\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Scalpel\">https:\/\/www.limswiki.org\/index.php\/Scalpel<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:53.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 383 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","739645b065bcad0f5a9e9e65c6d95099_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Scalpel skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Scalpel<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpel_(disambiguation)\" class=\"mw-disambig\" title=\"Scalpel (disambiguation)\" rel=\"external_link\" target=\"_blank\">Scalpel (disambiguation)<\/a>.<\/div>\n\n\n<p>A <b>scalpel<\/b>, or <b>lancet<\/b>, is a small and extremely sharp bladed instrument used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a>, anatomical <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dissection\" title=\"Dissection\" rel=\"external_link\" target=\"_blank\">dissection<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Podiatry\" title=\"Podiatry\" rel=\"external_link\" target=\"_blank\">podiatry<\/a> and various <a href=\"https:\/\/en.wikipedia.org\/wiki\/Handicraft\" title=\"Handicraft\" rel=\"external_link\" target=\"_blank\">arts and crafts<\/a> (called a <b>hobby knife<\/b>). Scalpels may be single-use disposable or re-usable. Re-usable scalpels can have permanently attached blades that can be sharpened or, more commonly, removable single-use blades. Disposable scalpels usually have a plastic handle with an extensible blade (like a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Utility_knife\" title=\"Utility knife\" rel=\"external_link\" target=\"_blank\">utility knife<\/a>) and are used once, then the entire instrument is discarded. Scalpel blades are usually individually packed in sterile pouches but are also offered non-sterile. Double-edged scalpels are referred to as \"lancets\".\n<\/p><p>Scalpel blades are usually made of hardened and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tempered_steel\" class=\"mw-redirect\" title=\"Tempered steel\" rel=\"external_link\" target=\"_blank\">tempered steel<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a>, or <a href=\"https:\/\/en.wikipedia.org\/wiki\/High_carbon_steel\" class=\"mw-redirect\" title=\"High carbon steel\" rel=\"external_link\" target=\"_blank\">high carbon steel<\/a>; in addition, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Titanium\" title=\"Titanium\" rel=\"external_link\" target=\"_blank\">titanium<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ceramic_knife\" title=\"Ceramic knife\" rel=\"external_link\" target=\"_blank\">ceramic<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Diamond\" title=\"Diamond\" rel=\"external_link\" target=\"_blank\">diamond<\/a> and even <a href=\"https:\/\/en.wikipedia.org\/wiki\/Obsidian\" title=\"Obsidian\" rel=\"external_link\" target=\"_blank\">obsidian<\/a> knives are not uncommon. For example, when performing surgery under <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnetic_resonance_imaging\" title=\"Magnetic resonance imaging\" rel=\"external_link\" target=\"_blank\">MRI<\/a> guidance, steel blades are unusable (the blades would be drawn to the magnets, or may cause image <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artifact_(medical_imaging)\" class=\"mw-redirect\" title=\"Artifact (medical imaging)\" rel=\"external_link\" target=\"_blank\">artifacts<\/a>). Historically, the preferred material for surgical scalpels was <a href=\"https:\/\/en.wikipedia.org\/wiki\/Silver\" title=\"Silver\" rel=\"external_link\" target=\"_blank\">silver<\/a>. Scalpel blades are also offered by select manufacturers with a zirconium nitride-coated edge to improve sharpness and edge retention. Others manufacture blades that are polymer-coated to enhance lubricity during a cut. Alternatives to scalpels in surgical applications include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cauterization#Electrocautery\" title=\"Cauterization\" rel=\"external_link\" target=\"_blank\">electrocautery<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Laser\" title=\"Laser\" rel=\"external_link\" target=\"_blank\">lasers<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Surgical_scalpels\">Surgical scalpels<\/span><\/h2>\n<div class=\"thumb tmulti tright\"><div class=\"thumbinner\" style=\"width:224px;max-width:224px\"><div class=\"tsingle\" style=\"margin:1px;width:222px;max-width:222px\"><div class=\"thumbimage\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Scalpel_handle_3.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Scalpel_handle_3.jpg\/220px-Scalpel_handle_3.jpg\" width=\"220\" height=\"124\" \/><\/a><\/div><\/div><div class=\"tsingle\" style=\"margin:1px;width:222px;max-width:222px\"><div class=\"thumbimage\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Disposable_scalpels-small_and_large.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Disposable_scalpels-small_and_large.jpg\/220px-Disposable_scalpels-small_and_large.jpg\" width=\"220\" height=\"76\" \/><\/a><\/div><div class=\"thumbcaption\" style=\"clear:left\">Reusable handle (top) and disposable scalpels (bottom)<\/div><\/div><\/div><\/div>\n<p>Surgical scalpels consist of two parts, a blade and a handle. The handles are often reusable, with the blades being replaceable. In medical applications, each blade is only used once (even if just for a single, small cut).\n<\/p><p>The handle is also known as a \"B.P. handle\", named after Charles Russell Bard and Morgan Parker, founders of the Bard-Parker Company. Morgan Parker patented the 2-piece scalpel design in 1915 and Bard-Parker developed a method of cold sterilization that would not dull the blades, as did the heat-based method that was previously used.<sup id=\"rdp-ebb-cite_ref-THIJ_Ochsner_1-0\" class=\"reference\"><a href=\"#cite_note-THIJ_Ochsner-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p><p>The handle of medical scalpels come in two basic types. The first is a flat handle used in the #3 and #4 handles. The #7 handle is more like a long writing pen, rounded at the front and flat at the back. A #4 handle is larger than a #3. Blades are manufactured with a corresponding fitment size so that they fit on only one size handle. The following table of blades is incomplete and some blades listed may work with handles not specified here.\n<\/p>\n<table class=\"wikitable\" style=\"\">\n<caption>Types of surgical scalpel blades\n<\/caption>\n<tbody><tr>\n<th>Blade No.<\/th>\n<th>Picture<\/th>\n<th>Compatible Handles<\/th>\n<th>Blade Description<\/th>\n<th>Uses\n<\/th><\/tr>\n<tr>\n<td>No. 6<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 9<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 10<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>Curved cutting edge with an unsharpened back edge. A more traditional blade shape.<\/td>\n<td>Generally for making incisions in skin and muscle. Commonly used to cut the skin in <a href=\"https:\/\/en.wikipedia.org\/wiki\/General_surgery\" title=\"General surgery\" rel=\"external_link\" target=\"_blank\">abdominal operations<\/a>.\n<\/td><\/tr>\n<tr>\n<td>No. 10a<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>This blade is a small and straight<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 11<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Scalpel11.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Scalpel11.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fd\/Scalpel11.jpg\/120px-Scalpel11.jpg\" width=\"120\" height=\"61\" \/><\/a><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>Triangular blade with sharp point, flat cutting edge parallel to the handle and flat back<\/td>\n<td>For precision cutting, stripping, sharp angle cuts and also <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stencil\" title=\"Stencil\" rel=\"external_link\" target=\"_blank\">stencil<\/a> cutting due to its similarity to the X-Acto artknife blade\n<\/td><\/tr>\n<tr>\n<td>No. 11P<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. E11<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. E\/11<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>Debriding hard skin for example <a href=\"https:\/\/en.wikipedia.org\/wiki\/Callus\" title=\"Callus\" rel=\"external_link\" target=\"_blank\">callus<\/a> by Podiatrists.\n<\/td><\/tr>\n<tr>\n<td>No. 12<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Scalpel12.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Scalpel12.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/Scalpel12.jpg\/120px-Scalpel12.jpg\" width=\"120\" height=\"55\" \/><\/a><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>A small, pointed, crescent-shaped blade sharpened on the inside edge of the curve<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 12D<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>A small, pointed, crescent-shaped blade sharpened on both sides of the curve<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 13<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 14<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 15<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_Blade.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Surgical Blade.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/29\/Surgical_Blade.jpg\/120px-Surgical_Blade.jpg\" width=\"120\" height=\"67\" \/><\/a><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>A smaller version of the #10<\/td>\n<td>For the same general use as the #10 blade\n<\/td><\/tr>\n<tr>\n<td>No. 15A<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>A front-facing straight blade with flat back<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 15C<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>The #15 with a downward angle, flatter and thinner than the #15<\/td>\n<td>The downward angle makes this the preferred blade for working within the chest during cardiac surgery, and is commonly used to make the distal arteriotomy during coronary artery bypass grafting.\n<\/td><\/tr>\n<tr>\n<td>No. 15T<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>Enucleation of lesions such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Corn_(medicine)\" title=\"Corn (medicine)\" rel=\"external_link\" target=\"_blank\">corns<\/a>.\n<\/td><\/tr>\n<tr>\n<td>No. D\/15<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 16<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>A narrow chisel-like blade with flat, angled cutting edge, positioned higher than the axis of the handle<\/td>\n<td>For cutting stencils, scoring and etching\n<\/td><\/tr>\n<tr>\n<td>No. 17<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td>A flat face 1.6 mm chisel blade<\/td>\n<td>For narrow cuts\n<\/td><\/tr>\n<tr>\n<td>No. 18<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A 12.7 mm chisel blade<\/td>\n<td>For deep cuts and scraping\n<\/td><\/tr>\n<tr>\n<td>No. 19<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A similar blade to the #15<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 20<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Scalpel20.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Scalpel20.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0c\/Scalpel20.jpg\/120px-Scalpel20.jpg\" width=\"120\" height=\"72\" \/><\/a><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A larger version of the #10 blade, with a curved cutting edge and a flat, unsharpened back edge.<\/td>\n<td>Used in general surgery and orthopaedic surgery.\n<\/td><\/tr>\n<tr>\n<td>No. 21<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Scalpel21.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Scalpel21.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/35\/Scalpel21.jpg\/120px-Scalpel21.jpg\" width=\"120\" height=\"69\" \/><\/a><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 22<\/td>\n<td><\/td>\n<td>2, 4, 5, 6<\/td>\n<td>A slightly larger version of the #20, with a curved cutting edge and a flat, unsharpened back edge.<\/td>\n<td>Used for skin incisions in both cardiac and thoracic surgery, and to cut the bronchus in lung resection surgery.\n<\/td><\/tr>\n<tr>\n<td>No. 22A<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 23<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Scalpel23.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Scalpel23.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7d\/Scalpel23.jpg\/120px-Scalpel23.jpg\" width=\"120\" height=\"74\" \/><\/a><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>Similar to #22, leaf-shaped<\/td>\n<td>For long incisions.\n<\/td><\/tr>\n<tr>\n<td>No. 24<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A wide, flat, angled cutting edge<\/td>\n<td>For corner cuts, trimming, stripping, and cutting mats and gaskets\n<\/td><\/tr>\n<tr>\n<td>No. 25<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A front-facing straight blade with flat back (similar to #15a)<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 25a<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A triangular straight blade with flat back edge taking a downwards angle (similar to #10a, shorter than #26)<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 26<\/td>\n<td><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Scalpel26.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Scalpel26.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/Scalpel26.jpg\/120px-Scalpel26.jpg\" width=\"120\" height=\"74\" \/><\/a><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A triangular straight blade with flat back edge taking a downwards angle (similar to the #15a, longer than #25a)<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 27<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 34<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A triangular blade similar to the #11<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 36<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A larger blade<\/td>\n<td>Used in general surgery but also within a Laboratory setting for Histology and Histopathology\n<\/td><\/tr>\n<tr>\n<td>No. 40<\/td>\n<td><\/td>\n<td>B3, 3, 3 Graduated, 3 Long, 5, 7, 9<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. PM40<\/td>\n<td><\/td>\n<td>Stainless PM Handle<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. PM40B<\/td>\n<td><\/td>\n<td>Stainless PM Handle<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. 60<\/td>\n<td><\/td>\n<td>4, 4 Graduated, 4 Long, 6<\/td>\n<td>A long blade resembling the #10 with a long cutting edge, rounded tip and flat back.<\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. PM60<\/td>\n<td><\/td>\n<td>PM8<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr>\n<tr>\n<td>No. PM60B<\/td>\n<td><\/td>\n<td>PM8<\/td>\n<td><\/td>\n<td>\n<\/td><\/tr><\/tbody><\/table>\n<h3><span class=\"mw-headline\" id=\"Gripping_a_medical_scalpel\">Gripping a medical scalpel<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:152px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ScalpelGrip_Palmar-Plain.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1d\/ScalpelGrip_Palmar-Plain.svg\/150px-ScalpelGrip_Palmar-Plain.svg.png\" width=\"150\" height=\"105\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ScalpelGrip_Palmar-Plain.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Palmar grip<\/div><\/div><\/div>\n<h4><span class=\"mw-headline\" id=\"Palmar_grip\">Palmar grip<\/span><\/h4>\n<p>Also called the \"dinner knife\" grip. The handle is held with the second through fourth fingers and secured along the base of the thumb, with the index finger extended along the top rear of the blade and the thumb along the side of the handle. This grip is best for initial incisions and larger cuts.\n<\/p>\n<h4><span class=\"mw-headline\" id=\"Pencil_grip\">Pencil grip<\/span><\/h4>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:152px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ScalpelGrip_Pencil-Plain.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/da\/ScalpelGrip_Pencil-Plain.svg\/150px-ScalpelGrip_Pencil-Plain.svg.png\" width=\"150\" height=\"105\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:ScalpelGrip_Pencil-Plain.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Pencil grip<\/div><\/div><\/div>\n<p>Best used for more accurate cuts with smaller blades (e.g. #15) and the #7 handle. The scalpel is held with the tips of the first and second fingers and the tip of the thumb with the handle resting on the fleshy base of the index finger and thumb. Care should be taken not to allow the handle to rest too far along the index finger as this promotes an unstable grip and cramped fingers.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Graphic_design_and_arts_and_crafts_blades\">Graphic design and arts and crafts blades<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:192px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Exacto_knife.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/07\/Exacto_knife.jpg\/190px-Exacto_knife.jpg\" width=\"190\" height=\"143\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Exacto_knife.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>X-Acto knife<\/div><\/div><\/div>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Graphic_design\" title=\"Graphic design\" rel=\"external_link\" target=\"_blank\">Graphical<\/a> and model-making scalpels tend to have round handles, with textured grips (either <a href=\"https:\/\/en.wikipedia.org\/wiki\/Knurling\" title=\"Knurling\" rel=\"external_link\" target=\"_blank\">knurled<\/a> metal or soft plastic). The blade is usually flat and straight, allowing it to be run easily against a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Straightedge\" title=\"Straightedge\" rel=\"external_link\" target=\"_blank\">straightedge<\/a> to produce straight cuts.\n<\/p><p>There are many kinds of graphic arts blades; the most common around the graphic design studio is the #11 blade which is very similar to a #11 surgical blade (q.v.). Other blade shapes are used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wood_carving\" title=\"Wood carving\" rel=\"external_link\" target=\"_blank\">wood carving<\/a>, cutting leather and heavy fabric, etc.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Ancient_scalpels\">Ancient scalpels<\/span><\/h2>\n<ul><li>Obsidian scalpels older than 2100 BC have been found in a Bronze Age settlement in Turkey.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup> Skulls from the same time and place show signs of brain surgery.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Egyptian_medicine\" title=\"Ancient Egyptian medicine\" rel=\"external_link\" target=\"_blank\">Ancient Egyptians<\/a> made incisions for embalming with scalpels of sharpened <a href=\"https:\/\/en.wikipedia.org\/wiki\/Obsidian\" title=\"Obsidian\" rel=\"external_link\" target=\"_blank\">obsidian<\/a>, a material that is still in use.<\/li>\n<li>The first medical writings of ancient Greeks indicate they were commonly using tools identical to today's scalpels around 500 BC.<sup id=\"rdp-ebb-cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\" rel=\"external_link\">[4]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine_in_ancient_Rome\" title=\"Medicine in ancient Rome\" rel=\"external_link\" target=\"_blank\">Ancient Romans<\/a> used more than 150 different surgical instruments, including scalpels.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup><\/li>\n<li>Indian <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ayurveda\" title=\"Ayurveda\" rel=\"external_link\" target=\"_blank\">Ayurvedic<\/a> medicine mentions the use of sharp <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bamboo\" title=\"Bamboo\" rel=\"external_link\" target=\"_blank\">bamboo<\/a> splinters.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (June 2010)\">citation needed<\/span><\/a><\/i>]<\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"Scalpel_injuries\">Scalpel injuries<\/span><\/h2>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Needlestick_injury\" title=\"Needlestick injury\" rel=\"external_link\" target=\"_blank\">Needlestick injury<\/a><\/div>\n<p>In the last decade,<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Dates_and_numbers#Chronological_items\" title=\"Wikipedia:Manual of Style\/Dates and numbers\" rel=\"external_link\" target=\"_blank\"><span title=\"The time period mentioned near this tag is ambiguous. (June 2012)\">when?<\/span><\/a><\/i>]<\/sup> a rising awareness of the dangers of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypodermic_needle\" title=\"Hypodermic needle\" rel=\"external_link\" target=\"_blank\">sharps<\/a> in a medical environment has led to the development of various methods of protecting healthcare workers from accidental cuts and puncture wounds. According to the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention\" title=\"Centers for Disease Control and Prevention\" rel=\"external_link\" target=\"_blank\">Centers for Disease Control and Prevention<\/a>, as many as 1,000 people each day are subject to accidental needle sticks and lacerations while providing medical care. Scalpel blade injuries are among the most frequent sharps injuries, second only to needlesticks. Scalpel injuries make up 7 percent to 8 percent of all sharps injuries.<sup id=\"rdp-ebb-cite_ref-Perry2003_6-0\" class=\"reference\"><a href=\"#cite_note-Perry2003-6\" rel=\"external_link\">[6]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-CDC_7-0\" class=\"reference\"><a href=\"#cite_note-CDC-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p><p>\"Scalpel Safety\" is a term coined to inform users that there are choices available to them to ensure their protection from this common sharps injury.<sup id=\"rdp-ebb-cite_ref-Sinnott2007_8-0\" class=\"reference\"><a href=\"#cite_note-Sinnott2007-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Safety_scalpels\">Safety scalpels<\/span><\/h3>\n<p>Safety scalpels are becoming increasingly popular as their prices come down and also on account of legislation such as the Needle Stick Prevention Act.<sup class=\"noprint Inline-Template\" style=\"margin-left:0.1em; white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Please_clarify\" title=\"Wikipedia:Please clarify\" rel=\"external_link\" target=\"_blank\"><span title=\"The text near this tag may need clarification or removal of jargon. (April 2013)\">clarification needed<\/span><\/a><\/i>]<\/sup>\nThere are essentially two kinds of disposable safety scalpels offered by various manufacturers. They can be either classified as retractable blade or retractable sheath type. The retractable blade version made by companies such as OX Med Tech, <a href=\"https:\/\/en.wikipedia.org\/wiki\/DeRoyal\" title=\"DeRoyal\" rel=\"external_link\" target=\"_blank\">DeRoyal<\/a>, Jai Surgicals, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Swann_Morton\" title=\"Swann Morton\" rel=\"external_link\" target=\"_blank\">Swann Morton<\/a>, and <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/penblade.net\" target=\"_blank\">PenBlade<\/a> are more intuitive to use due to their similarities to a standard box-cutter. Retractable sheath versions have much stronger ergonomic feel for the doctors and are made by companies such as , and .\nA few companies<sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Manual_of_Style\/Words_to_watch#Unsupported_attributions\" title=\"Wikipedia:Manual of Style\/Words to watch\" rel=\"external_link\" target=\"_blank\"><span title=\"The material near this tag possibly uses too-vague attribution or weasel words. (December 2016)\">who?<\/span><\/a><\/i>]<\/sup> have also started to offer a safety scalpel with a reusable metal handle. In such models, the blade is usually protected in a cartridge. Such systems usually require a custom handle and the price of blades and cartridges is considerably more than for conventional surgical blades.\n<\/p><p>However, CDC studies shows that up to 87% of active medical devices are not activated.<sup class=\"noprint Inline-Template\" style=\"margin-left:0.1em; white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Please_clarify\" title=\"Wikipedia:Please clarify\" rel=\"external_link\" target=\"_blank\"><span title=\"The text near this tag may need clarification or removal of jargon. (May 2013)\">clarification needed<\/span><\/a><\/i>]<\/sup> Safety scalpels are active devices and therefore the risk of not activating is still significant.<sup id=\"rdp-ebb-cite_ref-Alvarado-Ramy_9-0\" class=\"reference\"><a href=\"#cite_note-Alvarado-Ramy-9\" rel=\"external_link\">[9]<\/a><\/sup> There is a study that indicated there were actually four times more injuries with safety scalpels than reusable scalpels.<sup id=\"rdp-ebb-cite_ref-EPInet2005_10-0\" class=\"reference\"><a href=\"#cite_note-EPInet2005-10\" rel=\"external_link\">[10]<\/a><\/sup><sup class=\"noprint Inline-Template\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citing_sources#What_information_to_include\" title=\"Wikipedia:Citing sources\" rel=\"external_link\" target=\"_blank\"><span title=\"A complete citation is needed (July 2016)\">full citation needed<\/span><\/a><\/i>]<\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Blade_removers\">Blade removers<\/span><\/h3>\n<p>There are various scalpel blade removers on the market that allows users to safely remove blades from the handle, instead of dangerously using fingers or forceps. In the medical field, when taking into account activation rates, the combination of a single-handed scalpel blade remover with a passing tray or a neutral zone was as safe and up to five times safer than a safety scalpel.<sup id=\"rdp-ebb-cite_ref-Fuentes2008_11-0\" class=\"reference\"><a href=\"#cite_note-Fuentes2008-11\" rel=\"external_link\">[11]<\/a><\/sup> Companies like offers a single-handed scalpel blade remover that complies with regulatory requirements such as US <a href=\"https:\/\/en.wikipedia.org\/wiki\/Occupational_Safety_and_Health_Administration\" title=\"Occupational Safety and Health Administration\" rel=\"external_link\" target=\"_blank\">Occupational Safety and Health Administration<\/a> Standards.<sup id=\"rdp-ebb-cite_ref-OSHA2005_12-0\" class=\"reference\"><a href=\"#cite_note-OSHA2005-12\" rel=\"external_link\">[12]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Safety\">Safety<\/span><\/h3>\n<p>The usage of both safety scalpels and a single-handed blade remover, combined with a hands-free passing technique, are potentially effective in reducing scalpel blade injuries.<sup id=\"rdp-ebb-cite_ref-Fuentes2008_11-1\" class=\"reference\"><a href=\"#cite_note-Fuentes2008-11\" rel=\"external_link\">[11]<\/a><\/sup> It is up to employers and scalpel users to consider and use safer and more effective scalpel safety measures when feasible.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Laser_scalpel\" class=\"mw-redirect\" title=\"Laser scalpel\" rel=\"external_link\" target=\"_blank\">Laser scalpel<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_device\" title=\"Medical device\" rel=\"external_link\" target=\"_blank\">Medical device<\/a><\/li>\n<li><i><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Lancet\" title=\"The Lancet\" rel=\"external_link\" target=\"_blank\">The Lancet<\/a><\/i><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-THIJ_Ochsner-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-THIJ_Ochsner_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ochsner, J (2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2763477\" target=\"_blank\">\"Surgical knife\"<\/a>. <i>Texas Heart Institute Journal<\/i>. <b>36<\/b> (5): 441\u2013443. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2763477\" target=\"_blank\">2763477<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19876423\" target=\"_blank\">19876423<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Texas+Heart+Institute+Journal&rft.atitle=Surgical+knife&rft.volume=36&rft.issue=5&rft.pages=441-443&rft.date=2009&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2763477&rft_id=info%3Apmid%2F19876423&rft.aulast=Ochsner&rft.aufirst=J&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2763477&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Jo Marchant. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.newscientist.com\/article\/mg20727750-200-scalpels-and-skulls-point-to-bronze-age-brain-surgery\/\" target=\"_blank\">\"Scalpels and skulls point to Bronze Age brain surgery\"<\/a>. <i>New Scientist<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=New+Scientist&rft.atitle=Scalpels+and+skulls+point+to+Bronze+Age+brain+surgery&rft.au=Jo+Marchant&rft_id=https%3A%2F%2Fwww.newscientist.com%2Farticle%2Fmg20727750-200-scalpels-and-skulls-point-to-bronze-age-brain-surgery%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.hurriyetdailynews.com\/default.aspx?pageid=438&n=0717104921378-2010-07-19\" target=\"_blank\">\"ARTS-CULTURE \u2013 Excavations restarting at \u0130kiztepe in northern Turkey\"<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=ARTS-CULTURE+%E2%80%93+Excavations+restarting+at+%C4%B0kiztepe+in+northern+Turkey&rft_id=http%3A%2F%2Fwww.hurriyetdailynews.com%2Fdefault.aspx%3Fpageid%3D438%26n%3D0717104921378-2010-07-19&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-4\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Ochsner J (2009). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2763477\" target=\"_blank\">\"Surgical Knife\"<\/a>. <i>Tex Heart Inst J<\/i>. <b>36<\/b> (5): 441\u20133. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2763477\" target=\"_blank\">2763477<\/a><\/span>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19876423\" target=\"_blank\">19876423<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Tex+Heart+Inst+J&rft.atitle=Surgical+Knife&rft.volume=36&rft.issue=5&rft.pages=441-3&rft.date=2009&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2763477&rft_id=info%3Apmid%2F19876423&rft.au=Ochsner+J&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2763477&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation news\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.telegraph.co.uk\/news\/worldnews\/1572030\/Roman-ruins-cast-new-light-on-a-trip-to-doctor.html\" target=\"_blank\">\"Roman ruins cast new light on a trip to doctor\"<\/a>. <i>Telegraph.co.uk<\/i>. December 9, 2007.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Telegraph.co.uk&rft.atitle=Roman+ruins+cast+new+light+on+a+trip+to+doctor&rft.date=2007-12-09&rft_id=https%3A%2F%2Fwww.telegraph.co.uk%2Fnews%2Fworldnews%2F1572030%2FRoman-ruins-cast-new-light-on-a-trip-to-doctor.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Perry2003-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Perry2003_6-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Perry J, Parker G, Jagger J (2003). \"EPINet Report: 2001 Percutaneous Injury Rates\". <i>Advances in Exposure Prevention<\/i>. <b>6<\/b> (3): 32\u201336.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advances+in+Exposure+Prevention&rft.atitle=EPINet+Report%3A+2001+Percutaneous+Injury+Rates&rft.volume=6&rft.issue=3&rft.pages=32-36&rft.date=2003&rft.aulast=Perry&rft.aufirst=J&rft.au=Parker%2C+G&rft.au=Jagger%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-CDC-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-CDC_7-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.cdc.gov\/SharpsSafety\/workbook.html\" target=\"_blank\">\"Sharps Injury Prevention Workbook\"<\/a>. Cdc.gov (Centre for Disease Control and Prevention).<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Sharps+Injury+Prevention+Workbook&rft.pub=Cdc.gov+%28Centre+for+Disease+Control+and+Prevention%29&rft_id=https%3A%2F%2Fwww.cdc.gov%2FSharpsSafety%2Fworkbook.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Sinnott2007-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Sinnott2007_8-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Sinnott M.; Wall D. (2007). \"<span class=\"cs1-kern-left\">'<\/span>SCALPEL SAFETY': How safe (or dangerous) are safety scalpels?\". <i>International Journal of Surgery<\/i>. <b>6<\/b> (2): 176\u2013177. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1016%2Fj.ijsu.2007.01.010\" target=\"_blank\">10.1016\/j.ijsu.2007.01.010<\/a>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Surgery&rft.atitle=%27SCALPEL+SAFETY%27%3A+How+safe+%28or+dangerous%29+are+safety+scalpels%3F&rft.volume=6&rft.issue=2&rft.pages=176-177&rft.date=2007&rft_id=info%3Adoi%2F10.1016%2Fj.ijsu.2007.01.010&rft.au=Sinnott+M.&rft.au=Wall+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Alvarado-Ramy-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Alvarado-Ramy_9-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Alvarado-Ramy F, Beltrami EM, Short LJ, et al. (2003). \"A comprehensive approach to percutaneous injury prevention during phlebotomy: results of a multicentre study, 1993\u20131995\". <i>Infect Control Hosp Epidemiol<\/i>. <b>24<\/b> (2): 97\u2013104.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Infect+Control+Hosp+Epidemiol&rft.atitle=A+comprehensive+approach+to+percutaneous+injury+prevention+during+phlebotomy%3A+results+of+a+multicentre+study%2C+1993%E2%80%931995&rft.volume=24&rft.issue=2&rft.pages=97-104&rft.date=2003&rft.aulast=Alvarado-Ramy&rft.aufirst=F&rft.au=Beltrami%2C+EM&rft.au=Short%2C+LJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-EPInet2005-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-EPInet2005_10-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">\"Needlestick and Sharp-Object Injury Report. US EPINet Network\". <i>Advances in Exposure Prevention<\/i>. <b>7<\/b> (4): 44\u201345. 2005.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Advances+in+Exposure+Prevention&rft.atitle=Needlestick+and+Sharp-Object+Injury+Report.+US+EPINet+Network&rft.volume=7&rft.issue=4&rft.pages=44-45&rft.date=2005&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-Fuentes2008-11\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Fuentes2008_11-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Fuentes2008_11-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Fuentes, H., et al. (2008). \"Scalpel Safety\": Modeling the effectiveness of different safety devices' ability to reduce scalpel blade injuries.\" The International Journal of Risk & Safety in Medicine 20(1\u20132):83\u201389.<\/span>\n<\/li>\n<li id=\"cite_note-OSHA2005-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-OSHA2005_12-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.osha.gov\/pls\/oshaweb\/owadisp.show_document?p_table=INTERPRETATIONS&p_id=25339\" target=\"_blank\">\"OSHA Standard Interpretations \u2013 Use of passing trays and single-handed scalpel blade remover in a surgical setting\"<\/a>. Osha.gov. December 22, 2005.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=OSHA+Standard+Interpretations+%E2%80%93+Use+of+passing+trays+and+single-handed+scalpel+blade+remover+in+a+surgical+setting&rft.pub=Osha.gov&rft.date=2005-12-22&rft_id=https%3A%2F%2Fwww.osha.gov%2Fpls%2Foshaweb%2Fowadisp.show_document%3Fp_table%3DINTERPRETATIONS%26p_id%3D25339&rfr_id=info%3Asid%2Fen.wikipedia.org%3AScalpel\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1325\nCached time: 20181207053247\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.552 seconds\nReal time usage: 0.757 seconds\nPreprocessor visited node count: 1908\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 93927\/2097152 bytes\nTemplate argument size: 3512\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 9\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 29774\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.240\/10.000 seconds\nLua memory usage: 5.71 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 535.825 1 -total\n<\/p>\n<pre>30.42% 162.975 1 Template:Reflist\n21.04% 112.732 6 Template:Cite_journal\n13.31% 71.310 1 Template:Commons_category\n 9.13% 48.933 5 Template:Navbox\n 8.79% 47.089 1 Template:Refimprove\n 8.38% 44.913 4 Template:Fix\n 7.02% 37.639 1 Template:Ambox\n 6.79% 36.404 1 Template:Other_uses\n 6.40% 34.269 1 Template:Infobox_Tool\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:263748-1!canonical and timestamp 20181207053246 and revision id 861590271\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Scalpel\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214654\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.016 seconds\nReal time usage: 0.158 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 149.813 1 - wikipedia:Scalpel\n100.00% 149.813 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8557-0!*!*!*!*!*!* and timestamp 20181217214654 and revision id 24985\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Scalpel\">https:\/\/www.limswiki.org\/index.php\/Scalpel<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","739645b065bcad0f5a9e9e65c6d95099_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/9\/99\/Question_book-new.svg\/100px-Question_book-new.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/92\/Various_scalpels.png\/350px-Various_scalpels.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f8\/Scalpel_handle_3.jpg\/440px-Scalpel_handle_3.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Disposable_scalpels-small_and_large.jpg\/440px-Disposable_scalpels-small_and_large.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/fd\/Scalpel11.jpg\/240px-Scalpel11.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1f\/Scalpel12.jpg\/240px-Scalpel12.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/29\/Surgical_Blade.jpg\/240px-Surgical_Blade.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/0c\/Scalpel20.jpg\/240px-Scalpel20.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/35\/Scalpel21.jpg\/240px-Scalpel21.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/7d\/Scalpel23.jpg\/240px-Scalpel23.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/00\/Scalpel26.jpg\/240px-Scalpel26.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/1d\/ScalpelGrip_Palmar-Plain.svg\/300px-ScalpelGrip_Palmar-Plain.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/da\/ScalpelGrip_Pencil-Plain.svg\/300px-ScalpelGrip_Pencil-Plain.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/07\/Exacto_knife.jpg\/380px-Exacto_knife.jpg"],"739645b065bcad0f5a9e9e65c6d95099_timestamp":1545083214,"f1eaeb307bd9f4ff0eb6ba6223d56270_type":"article","f1eaeb307bd9f4ff0eb6ba6223d56270_title":"Retractor (medical)","f1eaeb307bd9f4ff0eb6ba6223d56270_url":"https:\/\/www.limswiki.org\/index.php\/Retractor_(medical)","f1eaeb307bd9f4ff0eb6ba6223d56270_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tRetractor (medical)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Surgical retractors\nA retractor is a surgical instrument used to separate the edges of a surgical incision or wound, or to hold back underlying organs and tissues so that body parts under the incision may be accessed. The general term retractor usually describes a simple handheld steel tool possessing a curved, hooked, or angled blade and fitted with a comfortable handle, that when in place maintains the desired position of a given region of tissue. These simple retractors may be handheld, clamped in place, or suspended at the end of a robotic arm. Retractors can also be self-retaining and not need to be held once inserted by having two or more opposing blades or hooks which are separated via spring, ratchet, worm gear or other method. The term retractor is also used to describe distinct, hand-cranked devices such as rib spreaders (also known as thoracic retractors, or distractors) with which surgeons may forcefully drive tissues apart to obtain exposure. For specialized situations such as spinal surgery, retractors have been fitted both with suction and with fiberoptic lights to keep a surgical wound dry and illuminated.\n\nContents \n\n1 History \n2 Current \n3 Gallery \n4 References \n\n\nHistory \nSurgical retractors probably originate with very basic tools used in the Stone Age.[1] Branches or antlers of various shapes were used to dig and extract food from the ground. As the use of tools evolved, a variety of instruments came about to substitute for the use of hooked or grasping fingers in the butchering of meat or dissection of bodies. The use of metals in tool making was of great importance. A variety of Roman metal instruments of the hook and retractor family have been found by archeologists. These instruments would generally be called hooks if the end was as narrow as the handle of the instrument. If the end was broad, it would be called a retractor. Also arising from this group of tools were other related tools for displacing (elevators and spatulas) and scooping (spoons and curettes).\nIn 4th century CE, Indian physician Susruta used surgical tools such as retractors. In a description of the procedure of tonsillectomy from the 7th century CE, Paul of Aegina documents the use of a tongue spatula to keep the tongue out of the way while a form of tonsil hook is used to bring the tonsil forward for excision. In 1000 CE Abu al-Qasim al-Zahrawi, also known as Albucasis or Abulcasis, described a variety of surgical instruments including retractors in his famous text Al-Tasrif.[citation needed ] Vesalius described a variety of hooks and retractors in the 16th century.[citation needed ] Jan Mikulicz-Radecki's invention of a hinged rib spreading retractor in 1904 prompted a flurry of development of retractors in the early 20th century, culminating in 1936 in our modern device based on the design of Enrique Finochietto.[2]\n\nCurrent \nThe following is an incomplete list of surgical retractors in use:[3]\n\n\nHAND HELD RETRACTORS\n\nHohmann Retractor\nLahey Retractor\nSenn Retractor\nBlair (Rollet) Retractor\nRigid Rake\nFlexible Rake\nRagnell Retractor\nLinde-Ragnell Retractor\nDavis Retractor\nVolkman Retractor\nKocher Retractor\nFarabeuf Retractor\nMathieu Retractor\nJackson Tracheal Hook\nCrile Retractor\nMeyerding Finger Retractor\nLittle Retractor\nLove Nerve Retractor\nGreen Retractor\nGoelet Retractor\nCushing Vein Retractor\nLangenbeck Retractor\nRichardson Retractor\nRichardson-Eastmann Retractor\nKelly Retractor\nDeaver Retractor\nDoyen Retractor\nParker Retractor\nParker-Mott Retractor\nRoux Retractor\nMayo-Collins Retractor\nU.S. Army Retractor\nRibbon Retractor\nSELF RETAINING RETRACTORS\n\nRultract Skyhook Retractor System\nAlm Retractor\nLone star retractor\nGelpi Retractor\nGutow Retractor\nWeitlaner Retractor\nBeckman-Weitlaner Retractor\nBeckman-Eaton Retractor\nBeckman Retractor\nAdson Retractor\nBalfour Retractor\nFinochietto Retractor or Rib Spreader\n\nGallery \n\n\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nDeaver retractor\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nArmy-Navy Retractor\n\n\t\t\t\n\t\t\n\t\t\n\t\t\t\n\t\t\t\nAmputation retractor\n\n\t\t\t\n\t\t\n\nReferences \n\n\n^ Kirkup, John (2006-05-15). The Evolution of Surgical Instruments \u2013 An Illustrated History from Ancient Times to the Twentieth Century. Norman Publishing. ISBN 978-0-930405-86-1. \n\n^ Bonfils-Roberts, E (May 1972). \"The Rib Spreader: A Chapter in the History of Thoracic Surgery\" (PDF) . Chest. 61 (5): 469\u2013474. doi:10.1378\/chest.61.5.469. PMID 4558402. Archived from the original (PDF) on 2008-12-17. Retrieved 2008-04-22 . \n\n^ \"General Instrument Sourcebook \u2013 KMedic\" (PDF) . Archived from the original (pdf) on November 12, 2006. Retrieved 2008-04-22 . \n\n\n\nFamous Canadian Physicians: Dr. Norman Bethune at Library and Archives Canada\n\nvteSurgical instrumentsDissectingScalpels\nLaser scalpel\nRF knife\nLancets\nListon knife\nCatlin\nVon Graefe knife\nSurgical scissors:\nBandage scissors\nIris scissors\nMayo scissors\nMetzenbaum scissors\nTenotomy scissors\nOther:\nRongeur\nCurette\nOsteotome\nDrill bits\nRasps\nTrocars\nDrills\nCranial drills\nDental drills\nDermatomes\nGrasping (forceps)\nBulldogs forceps\nHemostat\nObstetric\nVulsellum\nTenaculum\nDebakey forceps\nClamping\nFoerster clamp\nHemostat\nPennington clamp\nAortic cross-clamp\nGomco clamp\nAllis clamp\nRetracting\/viewing\nRetractors: Senn retractor\nRib spreader\nAccessory\/otherExamination\/prep:\nDilators\nSpecula\nFiber optic endoscopes\nHead mirror\nSuction:\nYankauer suction tip\n\nIrrigation and injection needles\nMeasurement devices:\nrulers and calipers\nDrain:\nJackson-Pratt drain\nPenrose drain\nOther:\nSurgical staplers\nPeriodontal probe\nSurgical suture\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Retractor_(medical)\">https:\/\/www.limswiki.org\/index.php\/Retractor_(medical)<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:52.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 480 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","f1eaeb307bd9f4ff0eb6ba6223d56270_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Retractor_medical skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Retractor (medical)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_retractor_Orem_2.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/de\/Surgical_retractor_Orem_2.jpg\/220px-Surgical_retractor_Orem_2.jpg\" width=\"220\" height=\"222\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_retractor_Orem_2.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Surgical retractors<\/div><\/div><\/div>\n<p>A <b>retractor<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instrument\" title=\"Surgical instrument\" rel=\"external_link\" target=\"_blank\">surgical instrument<\/a> used to separate the edges of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_incision\" title=\"Surgical incision\" rel=\"external_link\" target=\"_blank\">surgical incision<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wound\" title=\"Wound\" rel=\"external_link\" target=\"_blank\">wound<\/a>, or to hold back underlying <a href=\"https:\/\/en.wikipedia.org\/wiki\/Organ_(biology)\" class=\"mw-redirect\" title=\"Organ (biology)\" rel=\"external_link\" target=\"_blank\">organs<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tissue_(biology)\" title=\"Tissue (biology)\" rel=\"external_link\" target=\"_blank\">tissues<\/a> so that body parts under the incision may be accessed. The general term <i>retractor<\/i> usually describes a simple handheld steel tool possessing a curved, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hook\" title=\"Hook\" rel=\"external_link\" target=\"_blank\">hooked<\/a>, or angled blade and fitted with a comfortable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Handle_(grip)\" class=\"mw-redirect\" title=\"Handle (grip)\" rel=\"external_link\" target=\"_blank\">handle<\/a>, that when in place maintains the desired position of a given region of tissue. These simple retractors may be handheld, clamped in place, or suspended at the end of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Robotic_arm\" title=\"Robotic arm\" rel=\"external_link\" target=\"_blank\">robotic arm<\/a>. Retractors can also be self-retaining and not need to be held once inserted by having two or more opposing blades or hooks which are separated via <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spring_(device)\" title=\"Spring (device)\" rel=\"external_link\" target=\"_blank\">spring<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ratchet_(device)\" title=\"Ratchet (device)\" rel=\"external_link\" target=\"_blank\">ratchet<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Worm_gear\" class=\"mw-redirect\" title=\"Worm gear\" rel=\"external_link\" target=\"_blank\">worm gear<\/a> or other method. The term <i>retractor<\/i> is also used to describe distinct, hand-cranked devices such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rib_spreader\" title=\"Rib spreader\" rel=\"external_link\" target=\"_blank\">rib spreaders<\/a> (also known as thoracic retractors, or distractors) with which surgeons may forcefully drive tissues apart to obtain exposure. For specialized situations such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spinal_surgery\" class=\"mw-redirect\" title=\"Spinal surgery\" rel=\"external_link\" target=\"_blank\">spinal surgery<\/a>, retractors have been fitted both with suction and with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Fiberoptic\" class=\"mw-redirect\" title=\"Fiberoptic\" rel=\"external_link\" target=\"_blank\">fiberoptic<\/a> lights to keep a surgical wound dry and illuminated.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>Surgical retractors probably originate with very basic tools used in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stone_Age\" title=\"Stone Age\" rel=\"external_link\" target=\"_blank\">Stone Age<\/a>.<sup id=\"rdp-ebb-cite_ref-ESI_1-0\" class=\"reference\"><a href=\"#cite_note-ESI-1\" rel=\"external_link\">[1]<\/a><\/sup> Branches or antlers of various shapes were used to dig and extract food from the ground. As the use of tools evolved, a variety of instruments came about to substitute for the use of hooked or grasping fingers in the butchering of meat or dissection of bodies. The use of metals in tool making was of great importance. A variety of Roman metal instruments of the hook and retractor family have been found by archeologists. These instruments would generally be called hooks if the end was as narrow as the handle of the instrument. If the end was broad, it would be called a retractor. Also arising from this group of tools were other related tools for displacing (elevators and spatulas) and scooping (spoons and curettes).\n<\/p><p>In 4th century CE, Indian physician <a href=\"https:\/\/en.wikipedia.org\/wiki\/Susruta\" class=\"mw-redirect\" title=\"Susruta\" rel=\"external_link\" target=\"_blank\">Susruta<\/a> used surgical tools such as retractors. In a description of the procedure of tonsillectomy from the 7th century CE, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Paul_of_Aegina\" title=\"Paul of Aegina\" rel=\"external_link\" target=\"_blank\">Paul of Aegina<\/a> documents the use of a tongue spatula to keep the tongue out of the way while a form of tonsil hook is used to bring the tonsil forward for excision. In 1000 CE <a href=\"https:\/\/en.wikipedia.org\/wiki\/Abu_al-Qasim_al-Zahrawi\" class=\"mw-redirect\" title=\"Abu al-Qasim al-Zahrawi\" rel=\"external_link\" target=\"_blank\">Abu al-Qasim al-Zahrawi<\/a>, also known as Albucasis or Abulcasis, described a variety of surgical instruments including retractors in his famous text <a href=\"https:\/\/en.wikipedia.org\/wiki\/Al-Tasrif\" title=\"Al-Tasrif\" rel=\"external_link\" target=\"_blank\">Al-Tasrif<\/a>.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2010)\">citation needed<\/span><\/a><\/i>]<\/sup> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vesalius\" class=\"mw-redirect\" title=\"Vesalius\" rel=\"external_link\" target=\"_blank\">Vesalius<\/a> described a variety of hooks and retractors in the 16th century.<sup class=\"noprint Inline-Template Template-Fact\" style=\"white-space:nowrap;\">[<i><a href=\"https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Citation_needed\" title=\"Wikipedia:Citation needed\" rel=\"external_link\" target=\"_blank\"><span title=\"This claim needs references to reliable sources. (May 2010)\">citation needed<\/span><\/a><\/i>]<\/sup> Jan Mikulicz-Radecki's invention of a hinged rib spreading retractor in 1904 prompted a flurry of development of retractors in the early 20th century, culminating in 1936 in our modern device based on the design of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Enrique_Finochietto\" title=\"Enrique Finochietto\" rel=\"external_link\" target=\"_blank\">Enrique Finochietto<\/a>.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Current\">Current<\/span><\/h2>\n<p>The following is an incomplete list of surgical retractors in use:<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<div class=\"div-col columns column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em;\">\n<p>HAND HELD RETRACTORS\n<\/p>\n<ul><li>Hohmann Retractor<\/li>\n<li>Lahey Retractor<\/li>\n<li>Senn Retractor<\/li>\n<li>Blair (Rollet) Retractor<\/li>\n<li>Rigid Rake<\/li>\n<li>Flexible Rake<\/li>\n<li>Ragnell Retractor<\/li>\n<li>Linde-Ragnell Retractor<\/li>\n<li>Davis Retractor<\/li>\n<li>Volkman Retractor<\/li>\n<li>Kocher Retractor<\/li>\n<li>Farabeuf Retractor<\/li>\n<li>Mathieu Retractor<\/li>\n<li>Jackson Tracheal Hook<\/li>\n<li>Crile Retractor<\/li>\n<li>Meyerding Finger Retractor<\/li>\n<li>Little Retractor<\/li>\n<li>Love Nerve Retractor<\/li>\n<li>Green Retractor<\/li>\n<li>Goelet Retractor<\/li>\n<li>Cushing Vein Retractor<\/li>\n<li>Langenbeck Retractor<\/li>\n<li>Richardson Retractor<\/li>\n<li>Richardson-Eastmann Retractor<\/li>\n<li>Kelly Retractor<\/li>\n<li>Deaver Retractor<\/li>\n<li>Doyen Retractor<\/li>\n<li>Parker Retractor<\/li>\n<li>Parker-Mott Retractor<\/li>\n<li>Roux Retractor<\/li>\n<li>Mayo-Collins Retractor<\/li>\n<li>U.S. Army Retractor<\/li>\n<li>Ribbon Retractor<\/li><\/ul>\n<p>SELF RETAINING RETRACTORS\n<\/p>\n<ul><li>Rultract Skyhook Retractor System<\/li>\n<li>Alm Retractor<\/li>\n<li>Lone star retractor<\/li>\n<li>Gelpi Retractor<\/li>\n<li>Gutow Retractor<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Franz_Weitlaner\" title=\"Franz Weitlaner\" rel=\"external_link\" target=\"_blank\">Weitlaner<\/a> Retractor<\/li>\n<li>Beckman-Weitlaner Retractor<\/li>\n<li>Beckman-Eaton Retractor<\/li>\n<li>Beckman Retractor<\/li>\n<li>Adson Retractor<\/li>\n<li>Balfour Retractor<\/li>\n<li>Finochietto Retractor or Rib Spreader<\/li><\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Gallery\">Gallery<\/span><\/h2>\n<ul class=\"gallery mw-gallery-traditional\">\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:35px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_retractor.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"Surgical retractor.jpg\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a9\/Surgical_retractor.jpg\/120px-Surgical_retractor.jpg\" width=\"120\" height=\"80\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:30px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Deaver_retractor_01.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/86\/Deaver_retractor_01.JPG\/120px-Deaver_retractor_01.JPG\" width=\"120\" height=\"90\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Deaver retractor\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:41px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Surgical_retractor_Orem.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d1\/Surgical_retractor_Orem.jpg\/120px-Surgical_retractor_Orem.jpg\" width=\"120\" height=\"68\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Army-Navy Retractor\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n\t\t<li class=\"gallerybox\" style=\"width: 155px\"><div style=\"width: 155px\">\n\t\t\t<div class=\"thumb\" style=\"width: 150px;\"><div style=\"margin:39px auto;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Amputation_retractor.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ee\/Amputation_retractor.svg\/120px-Amputation_retractor.svg.png\" width=\"120\" height=\"72\" \/><\/a><\/div><\/div>\n\t\t\t<div class=\"gallerytext\">\n<p>Amputation retractor\n<\/p>\n\t\t\t<\/div>\n\t\t<\/div><\/li>\n<\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-ESI-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-ESI_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Kirkup, John (2006-05-15). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/books.google.com\/books?id=eg_SpXBf4eIC&pg=PA279&lpg=PA279&dq=history+retractor\" target=\"_blank\"><i>The Evolution of Surgical Instruments \u2013 An Illustrated History from Ancient Times to the Twentieth Century<\/i><\/a>. Norman Publishing. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-930405-86-1.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Evolution+of+Surgical+Instruments+%E2%80%93+An+Illustrated+History+from+Ancient+Times+to+the+Twentieth+Century&rft.pub=Norman+Publishing&rft.date=2006-05-15&rft.isbn=978-0-930405-86-1&rft.aulast=Kirkup&rft.aufirst=John&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Deg_SpXBf4eIC%26pg%3DPA279%26lpg%3DPA279%26dq%3Dhistory%2Bretractor&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetractor+%28medical%29\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bonfils-Roberts, E (May 1972). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20081217025255\/http:\/\/www.chestjournal.org\/cgi\/reprint\/61\/5\/469.pdf\" target=\"_blank\">\"The Rib Spreader: A Chapter in the History of Thoracic Surgery\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. <i>Chest<\/i>. <b>61<\/b> (5): 469\u2013474. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1378%2Fchest.61.5.469\" target=\"_blank\">10.1378\/chest.61.5.469<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Identifier\" class=\"mw-redirect\" title=\"PubMed Identifier\" rel=\"external_link\" target=\"_blank\">PMID<\/a> <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/4558402\" target=\"_blank\">4558402<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.chestjournal.org\/cgi\/reprint\/61\/5\/469.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2008-12-17<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2008-04-22<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Chest&rft.atitle=The+Rib+Spreader%3A+A+Chapter+in+the+History+of+Thoracic+Surgery&rft.volume=61&rft.issue=5&rft.pages=469-474&rft.date=1972-05&rft_id=info%3Adoi%2F10.1378%2Fchest.61.5.469&rft_id=info%3Apmid%2F4558402&rft.aulast=Bonfils-Roberts&rft.aufirst=E&rft_id=http%3A%2F%2Fwww.chestjournal.org%2Fcgi%2Freprint%2F61%2F5%2F469.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetractor+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20061112093646\/http:\/\/www.kmedicoem.com\/pdf\/GENERALS.PDF\" target=\"_blank\">\"General Instrument Sourcebook \u2013 KMedic\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.kmedicoem.com\/pdf\/GENERALS.PDF\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(pdf)<\/span> on November 12, 2006<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2008-04-22<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=General+Instrument+Sourcebook+%E2%80%93+KMedic&rft_id=http%3A%2F%2Fwww.kmedicoem.com%2Fpdf%2FGENERALS.PDF&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARetractor+%28medical%29\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<div class=\"refbegin\" style=\"\">\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.collectionscanada.ca\/physicians\/002032-210-e.html\" target=\"_blank\">Famous Canadian Physicians: Dr. Norman Bethune<\/a> at Library and Archives Canada<\/li><\/ul>\n<\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1247\nCached time: 20181128010333\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.216 seconds\nReal time usage: 0.300 seconds\nPreprocessor visited node count: 708\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 35128\/2097152 bytes\nTemplate argument size: 1086\/2097152 bytes\nHighest expansion depth: 11\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 12441\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.107\/10.000 seconds\nLua memory usage: 2.47 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 253.901 1 -total\n<\/p>\n<pre>43.81% 111.223 1 Template:Reflist\n32.06% 81.404 2 Template:Citation_needed\n24.94% 63.311 2 Template:Fix\n24.83% 63.053 1 Template:Cite_book\n15.35% 38.972 4 Template:Category_handler\n11.82% 30.016 1 Template:Cite_journal\n 7.71% 19.573 3 Template:Navbox\n 7.68% 19.506 2 Template:Delink\n 7.28% 18.484 1 Template:Surgical_instruments\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:2612628-1!canonical and timestamp 20181128010333 and revision id 836596222\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Retractor_%28medical%29\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214654\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.032 seconds\nReal time usage: 0.173 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 166.288 1 - wikipedia:Retractor_(medical)\n100.00% 166.288 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8556-0!*!*!*!*!*!* and timestamp 20181217214654 and revision id 24984\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Retractor_(medical)\">https:\/\/www.limswiki.org\/index.php\/Retractor_(medical)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","f1eaeb307bd9f4ff0eb6ba6223d56270_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/de\/Surgical_retractor_Orem_2.jpg\/440px-Surgical_retractor_Orem_2.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a9\/Surgical_retractor.jpg\/240px-Surgical_retractor.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/86\/Deaver_retractor_01.JPG\/240px-Deaver_retractor_01.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d1\/Surgical_retractor_Orem.jpg\/240px-Surgical_retractor_Orem.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/e\/ee\/Amputation_retractor.svg\/240px-Amputation_retractor.svg.png"],"f1eaeb307bd9f4ff0eb6ba6223d56270_timestamp":1545083214,"d3396438e09f98a8a1f26e591d7a278b_type":"article","d3396438e09f98a8a1f26e591d7a278b_title":"Forceps","d3396438e09f98a8a1f26e591d7a278b_url":"https:\/\/www.limswiki.org\/index.php\/Forceps","d3396438e09f98a8a1f26e591d7a278b_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tForceps\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tA handheld, hinged instrument used for grasping and holding objects\n Plastic forceps are intended to be disposable.\nForceps (plural forceps[1][2] or considered a plural noun without a singular, often a pair of forceps;[3][4] the Latin plural forcipes is no longer recorded in most dictionaries)[1][2][3][4] are a handheld, hinged instrument used for grasping and holding objects. Forceps are used when fingers are too large to grasp small objects or when many objects need to be held at one time while the hands are used to perform a task. The term \"forceps\" is used almost exclusively within the medical field. Outside medicine, people usually refer to forceps as tweezers, tongs, pliers, clips or clamps.\nMechanically, forceps employ the principle of the lever to grasp and apply pressure.\nDepending on their function, basic surgical forceps can be categorized into the following groups:\n\nNon-disposable forceps. They should withstand various kinds of physical and chemical effects of body fluids, secretions, cleaning agents, and sterilization methods.\nDisposable forceps. They are usually made of lower-quality materials or plastics which are disposed after use.\nSurgical forceps are commonly made of high-grade carbon steel, which ensures they can withstand repeated sterilization in high-temperature autoclaves. Some are made of other high-quality stainless steel, chromium and vanadium alloys to ensure durability of edges and restlessness. Lower-quality steel is used in forceps made for other uses. Some disposable forceps are made of plastic. The invention of surgical forceps is attributed to Stephen Hales.[5]\nThere are two basic types of forceps: non-locking (often called \"thumb forceps\" or \"pick-ups\") and locking, though these two types come in dozens of specialized forms for various uses. Non-locking forceps also come in two basic forms: hinged at one end, away from the grasping end (colloquially such forceps are called tweezers) and hinged in the middle, rather like scissors. Locking forceps are almost always hinged in the middle, though some forms place the hinge very close to the grasping end. Locking forceps use various means to lock the grasping surfaces in a closed position to facilitate manipulation or to independently clamp, grasp or hold an object.\n\nContents \n\n1 Thumb forceps \n2 Locking forceps \n\n2.1 Kelly forceps \n2.2 Other medical forceps \n\n\n3 See also \n4 References \n\n\nThumb forceps \n Blunt-nosed thumb forceps with serrated tips for increased grip\nSee also: Tweezers\nThumb forceps are commonly held between the thumb and two or three fingers of one hand, with the top end resting on the first dorsal interosseous muscle at the base of the thumb and index finger. Spring tension at one end holds the grasping ends apart until pressure is applied. This allows one to quickly and easily grasp small objects or tissue to move and release it or to grasp and hold tissue with easily variable pressure. Thumb forceps are used to hold tissue in place when applying sutures, to gently move tissues out of the way during exploratory surgery and to move dressings or draping without using the hands or fingers.\n\n Adson tissue forceps. Note the 1\u00d72 \"mouse's teeth\" on the lower tip.\nThumb forceps can have smooth tips, cross-hatched tips or serrated tips (often called \"mouse's teeth\"). Common arrangements of teeth are 1\u00d72 (two teeth on one side meshing with a single tooth on the other), 7\u00d77 and 9\u00d79. Serrated forceps are used on tissue; counter-intuitively, teeth will damage tissue less than a smooth surface because one can grasp with less overall pressure. Smooth or cross-hatched forceps are used to move dressings, remove sutures and similar tasks.\n\nLocking forceps \nLocking forceps, sometimes called clamps, are used to grasp and hold objects or tissue. When they are used to compress an artery to forestall bleeding, they are called hemostats. Another form of locking forceps is the needle holder, used to guide a suturing needle through tissue. Many locking forceps use finger loops to facilitate handling (see illustration, below, of Kelly forceps). The finger loops are usually grasped by the thumb and middle or ring fingers, while the index finger helps guide the instrument.\nThe most common locking mechanism is a series of interlocking teeth located near the finger loops. As the forceps are closed, the teeth engage and keep the instrument's grasping surfaces from separating. A simple shift of the fingers is all that is needed to disengage the teeth and allow the grasping ends to move apart. Forceps are also used for surgery.\n\nKelly forceps \n Kelly forceps, shown closed and open\nKelly forceps are a type of hemostat usually made of stainless steel. They resemble a pair of scissors with the blade replaced by a blunted grip. They also feature a locking mechanism to allow them to act as clamps.\nKelly forceps may be floor-grade (regular use) and as such not used for surgery. They may also be sterilized and used in operations, in both human and veterinary medicine. They may be either curved or straight. In surgery, they may be used for occluding blood vessels, manipulating tissues, or for assorted other purposes.\nThey are named for Howard Atwood Kelly, M.D., first professor of obstetrics and gynecology at the Johns Hopkins School of Medicine.\nThe \"mosquito\" variant of the tool is more delicate and has smaller, finer tips. Other varieties with similar, if more specialized, uses are Allis clamps, Babcocks, Kochers, Carmalts, and tonsils; all but the last bear the names of the surgeons who designed them.\n\nOther medical forceps \nOther types of forceps include:\n\n Magill forceps, which are angled forceps used to guide a tracheal tube into the larynx or a nasogastric tube into the esophagus under direct vision.[6] They are also used to remove foreign bodies.[6]\nAlligator forceps\nAnesthesia forceps\nArtery forceps\nAtraumatic forceps\nBiopsy forceps\nBone-cutting forceps\nBone-reduction forceps\nBone-holding forceps\nBulldogs forceps\nCatheter forceps\nCilia forceps\nCurettes forceps\nCushing forceps\nDebakey forceps\nDermal forceps & nippers\nDressing forceps\nEar forceps\nEye forceps\nGallbladder forceps\nGerald forceps\nHemostatic forceps\nHysterectomy forceps\nIntestinal forceps\nMicrosurgery forceps\nNasal forceps\nObstetrical forceps\nPostmortem forceps\nSplinter forceps\nSponge forceps\nSpreading forceps\nSterilizer forceps\nSuture sundries forceps\nTenaculum forceps\nThoracic forceps\nThoracic surgical forceps\nThumb forceps\nTissue forceps\nTongue forceps\nTooth extracting forceps\nTubing forceps\nUterine forceps\nVulsellum forceps\nWire cutting forceps\nSee also \n\n\n\nWikimedia Commons has media related to Forceps.\nReferences \n\n\n^ a b Company, Houghton Mifflin Harcourt Publishing. \"The American Heritage Dictionary entry: forceps\". www.ahdictionary.com. Retrieved 30 August 2018 . \n\n^ a b \"Definition of FORCEPS\". www.merriam-webster.com. Retrieved 30 August 2018 . \n\n^ a b \"forceps Meaning in the Cambridge English Dictionary\". dictionary.cambridge.org. Retrieved 30 August 2018 . \n\n^ a b \"forceps - Definition of forceps in English by Oxford Dictionaries\". Oxford Dictionaries - English. Retrieved 30 August 2018 . \n\n^ Scientific American inventions and discoveries By Rodney P. Carlisle. \n\n^ a b Magill forceps in Farlex medical dictionary, citing Mosby's Medical Dictionary, 8th edition. \n\n\nvteSurgical instrumentsDissectingScalpels\nLaser scalpel\nRF knife\nLancets\nListon knife\nCatlin\nVon Graefe knife\nSurgical scissors:\nBandage scissors\nIris scissors\nMayo scissors\nMetzenbaum scissors\nTenotomy scissors\nOther:\nRongeur\nCurette\nOsteotome\nDrill bits\nRasps\nTrocars\nDrills\nCranial drills\nDental drills\nDermatomes\nGrasping (forceps)\nBulldogs forceps\nHemostat\nObstetric\nVulsellum\nTenaculum\nDebakey forceps\nClamping\nFoerster clamp\nHemostat\nPennington clamp\nAortic cross-clamp\nGomco clamp\nAllis clamp\nRetracting\/viewing\nRetractors: Senn retractor\nRib spreader\nAccessory\/otherExamination\/prep:\nDilators\nSpecula\nFiber optic endoscopes\nHead mirror\nSuction:\nYankauer suction tip\n\nIrrigation and injection needles\nMeasurement devices:\nrulers and calipers\nDrain:\nJackson-Pratt drain\nPenrose drain\nOther:\nSurgical 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:51.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 491 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","d3396438e09f98a8a1f26e591d7a278b_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Forceps skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Forceps<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"shortdescription nomobile noexcerpt noprint searchaux\" style=\"display:none\">A handheld, hinged instrument used for grasping and holding objects<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:177px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Forceps_plastic.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/55\/Forceps_plastic.jpg\/175px-Forceps_plastic.jpg\" width=\"175\" height=\"79\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Forceps_plastic.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Plastic forceps are intended to be disposable.<\/div><\/div><\/div>\n<p><i>Forceps<\/i> (plural <b>forceps<\/b><sup id=\"rdp-ebb-cite_ref-ahd_1-0\" class=\"reference\"><a href=\"#cite_note-ahd-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-mw_2-0\" class=\"reference\"><a href=\"#cite_note-mw-2\" rel=\"external_link\">[2]<\/a><\/sup> or considered a plural noun without a singular, often <b>a pair of forceps<\/b>;<sup id=\"rdp-ebb-cite_ref-cambridge_3-0\" class=\"reference\"><a href=\"#cite_note-cambridge-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-oxford_4-0\" class=\"reference\"><a href=\"#cite_note-oxford-4\" rel=\"external_link\">[4]<\/a><\/sup> the Latin plural <i>forcipes<\/i> is no longer recorded in most dictionaries)<sup id=\"rdp-ebb-cite_ref-ahd_1-1\" class=\"reference\"><a href=\"#cite_note-ahd-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-mw_2-1\" class=\"reference\"><a href=\"#cite_note-mw-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-cambridge_3-1\" class=\"reference\"><a href=\"#cite_note-cambridge-3\" rel=\"external_link\">[3]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-oxford_4-1\" class=\"reference\"><a href=\"#cite_note-oxford-4\" rel=\"external_link\">[4]<\/a><\/sup> are a handheld, hinged instrument used for grasping and holding objects. Forceps are used when fingers are too large to grasp small objects or when many objects need to be held at one time while the hands are used to perform a task. The term \"forceps\" is used almost exclusively within the medical field. Outside medicine, people usually refer to forceps as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tweezers\" title=\"Tweezers\" rel=\"external_link\" target=\"_blank\">tweezers<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tongs\" title=\"Tongs\" rel=\"external_link\" target=\"_blank\">tongs<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pliers\" title=\"Pliers\" rel=\"external_link\" target=\"_blank\">pliers<\/a>, clips or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Clamp_(tool)\" title=\"Clamp (tool)\" rel=\"external_link\" target=\"_blank\">clamps<\/a>.\n<\/p><p>Mechanically, forceps employ the principle of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lever\" title=\"Lever\" rel=\"external_link\" target=\"_blank\">lever<\/a> to grasp and apply pressure.\n<\/p><p>Depending on their function, basic surgical forceps can be categorized into the following groups:\n<\/p>\n<ol><li>Non-disposable forceps. They should withstand various kinds of physical and chemical effects of body fluids, secretions, cleaning agents, and sterilization methods.<\/li>\n<li>Disposable forceps. They are usually made of lower-quality materials or plastics which are disposed after use.<\/li><\/ol>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">Surgical<\/a> forceps are commonly made of high-grade <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carbon_steel\" title=\"Carbon steel\" rel=\"external_link\" target=\"_blank\">carbon steel<\/a>, which ensures they can withstand repeated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Sterilization_(microbiology)\" title=\"Sterilization (microbiology)\" rel=\"external_link\" target=\"_blank\">sterilization<\/a> in high-temperature <a href=\"https:\/\/en.wikipedia.org\/wiki\/Autoclave\" title=\"Autoclave\" rel=\"external_link\" target=\"_blank\">autoclaves<\/a>. Some are made of other high-quality <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stainless_steel\" title=\"Stainless steel\" rel=\"external_link\" target=\"_blank\">stainless steel<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chromium\" title=\"Chromium\" rel=\"external_link\" target=\"_blank\">chromium<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vanadium\" title=\"Vanadium\" rel=\"external_link\" target=\"_blank\">vanadium<\/a> alloys to ensure durability of edges and restlessness. Lower-quality steel is used in forceps made for other uses. Some <a href=\"https:\/\/en.wikipedia.org\/wiki\/Disposable\" class=\"mw-redirect\" title=\"Disposable\" rel=\"external_link\" target=\"_blank\">disposable<\/a> forceps are made of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plastic\" title=\"Plastic\" rel=\"external_link\" target=\"_blank\">plastic<\/a>. The invention of surgical forceps is attributed to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Stephen_Hales\" title=\"Stephen Hales\" rel=\"external_link\" target=\"_blank\">Stephen Hales<\/a>.<sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p><p>There are two basic types of forceps: non-locking (often called \"thumb forceps\" or \"pick-ups\") and locking, though these two types come in dozens of specialized forms for various uses. Non-locking forceps also come in two basic forms: hinged at one end, away from the grasping end (colloquially such forceps are called tweezers) and hinged in the middle, rather like <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scissors\" title=\"Scissors\" rel=\"external_link\" target=\"_blank\">scissors<\/a>. Locking forceps are almost always hinged in the middle, though some forms place the hinge very close to the grasping end. Locking forceps use various means to lock the grasping surfaces in a closed position to facilitate manipulation or to independently clamp, grasp or hold an object.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Thumb_forceps\">Thumb forceps<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Forceps.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a4\/Forceps.jpg\/220px-Forceps.jpg\" width=\"220\" height=\"147\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Forceps.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Blunt-nosed thumb forceps with serrated tips for increased grip<\/div><\/div><\/div>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">See also: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tweezers\" title=\"Tweezers\" rel=\"external_link\" target=\"_blank\">Tweezers<\/a><\/div>\n<p>Thumb forceps are commonly held between the thumb and two or three fingers of one hand, with the top end resting on the first <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dorsal_interossei_of_the_hand\" title=\"Dorsal interossei of the hand\" rel=\"external_link\" target=\"_blank\">dorsal interosseous muscle<\/a> at the base of the thumb and index finger. Spring tension at one end holds the grasping ends apart until pressure is applied. This allows one to quickly and easily grasp small objects or tissue to move and release it or to grasp and hold tissue with easily variable pressure. Thumb forceps are used to hold tissue in place when applying sutures, to gently move tissues out of the way during exploratory surgery and to move dressings or draping without using the hands or fingers.\n<\/p>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Adson_forceps.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Adson_forceps.svg\/220px-Adson_forceps.svg.png\" width=\"220\" height=\"73\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Adson_forceps.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Adson tissue forceps. Note the 1\u00d72 \"mouse's teeth\" on the lower tip.<\/div><\/div><\/div>\n<p>Thumb forceps can have smooth tips, cross-hatched tips or serrated tips (often called \"mouse's teeth\"). Common arrangements of teeth are 1\u00d72 (two teeth on one side meshing with a single tooth on the other), 7\u00d77 and 9\u00d79. Serrated forceps are used on tissue; counter-intuitively, teeth will damage tissue less than a smooth surface because one can grasp with less overall pressure. Smooth or cross-hatched forceps are used to move dressings, remove sutures and similar tasks.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Locking_forceps\">Locking forceps<\/span><\/h2>\n<p>Locking forceps, sometimes called clamps, are used to grasp and hold objects or tissue. When they are used to compress an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Artery\" title=\"Artery\" rel=\"external_link\" target=\"_blank\">artery<\/a> to forestall bleeding, they are called <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemostat\" title=\"Hemostat\" rel=\"external_link\" target=\"_blank\">hemostats<\/a>. Another form of locking forceps is the needle holder, used to guide a suturing needle through tissue. Many locking forceps use finger loops to facilitate handling (see illustration, below, of Kelly forceps). The finger loops are usually grasped by the thumb and middle or ring fingers, while the index finger helps guide the instrument.\n<\/p><p>The most common locking mechanism is a series of interlocking teeth located near the finger loops. As the forceps are closed, the teeth engage and keep the instrument's grasping surfaces from separating. A simple shift of the fingers is all that is needed to disengage the teeth and allow the grasping ends to move apart. Forceps are also used for surgery.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Kelly_forceps\">Kelly forceps<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kelly_Forceps.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/b\/b5\/Kelly_Forceps.svg\/220px-Kelly_Forceps.svg.png\" width=\"220\" height=\"243\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Kelly_Forceps.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Kelly forceps, shown closed and open<\/div><\/div><\/div>\n<p>Kelly forceps are a type of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemostat\" title=\"Hemostat\" rel=\"external_link\" target=\"_blank\">hemostat<\/a> usually made of stainless steel. They resemble a pair of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scissor\" class=\"mw-redirect\" title=\"Scissor\" rel=\"external_link\" target=\"_blank\">scissors<\/a> with the blade replaced by a blunted grip. They also feature a locking mechanism to allow them to act as clamps.\nKelly forceps may be floor-grade (regular use) and as such not used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgery\" title=\"Surgery\" rel=\"external_link\" target=\"_blank\">surgery<\/a>. They may also be sterilized and used in operations, in both human and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Veterinary\" class=\"mw-redirect\" title=\"Veterinary\" rel=\"external_link\" target=\"_blank\">veterinary<\/a> medicine. They may be either curved or straight. In surgery, they may be used for occluding <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_vessel\" title=\"Blood vessel\" rel=\"external_link\" target=\"_blank\">blood vessels<\/a>, manipulating tissues, or for assorted other purposes.\nThey are named for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Howard_Atwood_Kelly\" title=\"Howard Atwood Kelly\" rel=\"external_link\" target=\"_blank\">Howard Atwood Kelly<\/a>, M.D., first professor of obstetrics and gynecology at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Johns_Hopkins_School_of_Medicine\" title=\"Johns Hopkins School of Medicine\" rel=\"external_link\" target=\"_blank\">Johns Hopkins School of Medicine<\/a>.\nThe \"mosquito\" variant of the tool is more delicate and has smaller, finer tips. Other varieties with similar, if more specialized, uses are Allis clamps, Babcocks, Kochers, Carmalts, and tonsils; all but the last bear the names of the surgeons who designed them.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Other_medical_forceps\">Other medical forceps<\/span><\/h3>\n<p>Other types of forceps include:\n<\/p>\n<ul><li><span id=\"rdp-ebb-Magill\"><\/span><i>Magill forceps<\/i>, which are angled forceps used to guide a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Tracheal_tube\" title=\"Tracheal tube\" rel=\"external_link\" target=\"_blank\">tracheal tube<\/a> into the larynx or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nasogastric_tube\" class=\"mw-redirect\" title=\"Nasogastric tube\" rel=\"external_link\" target=\"_blank\">nasogastric tube<\/a> into the esophagus under direct vision.<sup id=\"rdp-ebb-cite_ref-magill_6-0\" class=\"reference\"><a href=\"#cite_note-magill-6\" rel=\"external_link\">[6]<\/a><\/sup> They are also used to remove <a href=\"https:\/\/en.wikipedia.org\/wiki\/Foreign_bodies\" class=\"mw-redirect\" title=\"Foreign bodies\" rel=\"external_link\" target=\"_blank\">foreign bodies<\/a>.<sup id=\"rdp-ebb-cite_ref-magill_6-1\" class=\"reference\"><a href=\"#cite_note-magill-6\" rel=\"external_link\">[6]<\/a><\/sup><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hartmann_alligator_forceps\" title=\"Hartmann alligator forceps\" rel=\"external_link\" target=\"_blank\">Alligator forceps<\/a><\/li>\n<li>Anesthesia forceps<\/li>\n<li>Artery forceps<\/li>\n<li>Atraumatic forceps<\/li>\n<li>Biopsy forceps<\/li>\n<li>Bone-cutting forceps<\/li>\n<li>Bone-reduction forceps<\/li>\n<li>Bone-holding forceps<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bulldogs_forceps\" title=\"Bulldogs forceps\" rel=\"external_link\" target=\"_blank\">Bulldogs forceps<\/a><\/li>\n<li>Catheter forceps<\/li>\n<li>Cilia forceps<\/li>\n<li>Curettes forceps<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Harvey_Williams_Cushing#Legacy\" class=\"mw-redirect\" title=\"Harvey Williams Cushing\" rel=\"external_link\" target=\"_blank\">Cushing forceps<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Debakey_forceps\" title=\"Debakey forceps\" rel=\"external_link\" target=\"_blank\">Debakey forceps<\/a><\/li>\n<li>Dermal forceps & nippers<\/li>\n<li>Dressing forceps<\/li>\n<li>Ear forceps<\/li>\n<li>Eye forceps<\/li>\n<li>Gallbladder forceps<\/li>\n<li>Gerald forceps<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemostat\" title=\"Hemostat\" rel=\"external_link\" target=\"_blank\">Hemostatic forceps<\/a><\/li>\n<li>Hysterectomy forceps<\/li>\n<li>Intestinal forceps<\/li>\n<li>Microsurgery forceps<\/li>\n<li>Nasal forceps<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Forceps_in_childbirth\" class=\"mw-redirect\" title=\"Forceps in childbirth\" rel=\"external_link\" target=\"_blank\">Obstetrical forceps<\/a><\/li>\n<li>Postmortem forceps<\/li>\n<li>Splinter forceps<\/li>\n<li>Sponge forceps<\/li>\n<li>Spreading forceps<\/li>\n<li>Sterilizer forceps<\/li>\n<li>Suture sundries forceps<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Tenaculum\" title=\"Tenaculum\" rel=\"external_link\" target=\"_blank\">Tenaculum<\/a> forceps<\/li>\n<li>Thoracic forceps<\/li>\n<li>Thoracic surgical forceps<\/li>\n<li>Thumb forceps<\/li>\n<li>Tissue forceps<\/li>\n<li>Tongue forceps<\/li>\n<li>Tooth extracting forceps<\/li>\n<li>Tubing forceps<\/li>\n<li>Uterine forceps<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Vulsellum\" title=\"Vulsellum\" rel=\"external_link\" target=\"_blank\">Vulsellum forceps<\/a><\/li>\n<li>Wire cutting forceps<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-ahd-1\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-ahd_1-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-ahd_1-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\">Company, Houghton Mifflin Harcourt Publishing. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ahdictionary.com\/word\/search.html?q=forceps.\" target=\"_blank\">\"The American Heritage Dictionary entry: forceps\"<\/a>. <i>www.ahdictionary.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">30 August<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.ahdictionary.com&rft.atitle=The+American+Heritage+Dictionary+entry%3A+forceps.&rft.aulast=Company&rft.aufirst=Houghton+Mifflin+Harcourt+Publishing&rft_id=https%3A%2F%2Fwww.ahdictionary.com%2Fword%2Fsearch.html%3Fq%3Dforceps.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AForceps\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-mw-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-mw_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-mw_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.merriam-webster.com\/dictionary\/forceps.\" target=\"_blank\">\"Definition of FORCEPS\"<\/a>. <i>www.merriam-webster.com<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">30 August<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.merriam-webster.com&rft.atitle=Definition+of+FORCEPS&rft_id=https%3A%2F%2Fwww.merriam-webster.com%2Fdictionary%2Fforceps.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AForceps\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-cambridge-3\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-cambridge_3-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-cambridge_3-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/dictionary.cambridge.org\/dictionary\/english\/forceps?a=british.\" target=\"_blank\">\"forceps Meaning in the Cambridge English Dictionary\"<\/a>. <i>dictionary.cambridge.org<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">30 August<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=dictionary.cambridge.org&rft.atitle=forceps+Meaning+in+the+Cambridge+English+Dictionary&rft_id=http%3A%2F%2Fdictionary.cambridge.org%2Fdictionary%2Fenglish%2Fforceps%3Fa%3Dbritish.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AForceps\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-oxford-4\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-oxford_4-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-oxford_4-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.oxforddictionaries.com\/definition\/forceps.\" target=\"_blank\">\"forceps - Definition of forceps in English by Oxford Dictionaries\"<\/a>. <i>Oxford Dictionaries - English<\/i><span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">30 August<\/span> 2018<\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Oxford+Dictionaries+-+English&rft.atitle=forceps+-+Definition+of+forceps+in+English+by+Oxford+Dictionaries&rft_id=https%3A%2F%2Fen.oxforddictionaries.com%2Fdefinition%2Fforceps.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AForceps\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Scientific American inventions and discoveries By Rodney P. Carlisle.<\/span>\n<\/li>\n<li id=\"cite_note-magill-6\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-magill_6-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-magill_6-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/medical-dictionary.thefreedictionary.com\/Magill+forceps\" target=\"_blank\">Magill forceps<\/a> in Farlex medical dictionary, citing Mosby's Medical Dictionary, 8th edition.<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1270\nCached time: 20181213125525\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.308 seconds\nReal time usage: 0.409 seconds\nPreprocessor visited node count: 581\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 33219\/2097152 bytes\nTemplate argument size: 430\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 11941\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.148\/10.000 seconds\nLua memory usage: 3.6 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 317.043 1 -total\n<\/p>\n<pre>43.28% 137.204 1 Template:Reflist\n36.22% 114.821 4 Template:Cite_web\n23.44% 74.326 1 Template:Commons_category\n13.66% 43.294 1 Template:Short_description\n12.51% 39.662 1 Template:Pagetype\n10.68% 33.866 3 Template:Navbox\n 9.61% 30.455 1 Template:Surgical_instruments\n 4.54% 14.403 1 Template:Commons\n 4.54% 14.393 1 Template:See_also\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:638969-1!canonical and timestamp 20181213125524 and revision id 873464072\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Forceps\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214654\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.163 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 156.804 1 - wikipedia:Forceps\n100.00% 156.804 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8555-0!*!*!*!*!*!* and timestamp 20181217214654 and revision id 24983\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Forceps\">https:\/\/www.limswiki.org\/index.php\/Forceps<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","d3396438e09f98a8a1f26e591d7a278b_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/55\/Forceps_plastic.jpg\/350px-Forceps_plastic.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/a4\/Forceps.jpg\/440px-Forceps.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/25\/Adson_forceps.svg\/440px-Adson_forceps.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/b\/b5\/Kelly_Forceps.svg\/440px-Kelly_Forceps.svg.png"],"d3396438e09f98a8a1f26e591d7a278b_timestamp":1545083213,"053eab61e093aea2255f4b96741fb09f_type":"article","053eab61e093aea2255f4b96741fb09f_title":"Dermatome (instrument)","053eab61e093aea2255f4b96741fb09f_url":"https:\/\/www.limswiki.org\/index.php\/Dermatome_(instrument)","053eab61e093aea2255f4b96741fb09f_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tDermatome (instrument)\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor other uses, see Dermatome.\n Diagram of a dermatome\nA dermatome is a surgical instrument used to produce thin slices of skin from a donor area, in order to use them for making skin grafts. One of its main applications is for reconstituting skin areas damaged by grade 3 burns or trauma.\nDermatomes can be operated either manually or electrically. The first drum dermatomes, developed in the 1930s, were manually operated. Afterwards, dermatomes which were operated by air pressure, such as the Brown dermatome, achieved higher speed and precision. Electrical dermatomes are better for cutting out thinner and longer strips of skin with a more homogeneous thickness.\n\nContents \n\n1 Free-hand knives \n2 Types of dermatomes \n\n2.1 Knives \n2.2 Drum \n2.3 Electric \n2.4 Air \n\n\n3 See also \n4 References \n\n\nFree-hand knives \nThose are manual dermatomes and the term knife or scalpel is used to describe them. Their disadvantages are harvesting of grafts with irregular edges and grafts of variable thickness. Their operator has to be experienced in their use for optimal results.[1]\n\nTypes of dermatomes \n Side view of a drum dermatome blade (24) removing a slice of skin (38 and 40).\nThere are several types of dermatomes, usually named after their inventor.\n\nKnives \nBlair\/Brown knife.\nHumby knife, similar to the Blair knife with the addition of an adjustable roller which controls the thickness of the graft taken.[2]\nBraithwaite knife.\nWatson knife, another modified version of the Braithwaite knife.\nCobbett knife, a modified version of the Braithwaite knife.\nGoulian\/Weck knife.\nSilver knife, ideal for the harvesting of small grafts.\nDrum \nPadgett dermatome, was the first rotary drum manual dermatome to be devised.\nReese dermatome.\nElectric \nBrown dermatome, the first with powered rotation to be developed, used mostly for large skin grafts. It is electrically operated.\nCastroviejo dermatome, also electrically operated, is a precision dermatome with a small head and controllable thickness, which is most used for mucous membrane grafts.\nAir \nAir dermatome, the most commonly used dermatome used worldwide today, used mostly for large skin grafts.[3]\nSee also \nInstruments used in general surgery\nReferences \n\n\n^ David L. Brown, Gregory H. Borschel, Michigan Manual of Plastic Surgery \n\n^ Ian A. McGregor, Fundamental Techniques of Plastic Surgery and Their Surgical Applications \n\n^ \"Tiny Air Turbines Drive Surgical Instruments..\" Popular Science, September 1966, pp. 82-83. \n\n\nvteSurgical instrumentsDissectingScalpels\nLaser scalpel\nRF knife\nLancets\nListon knife\nCatlin\nVon Graefe knife\nSurgical scissors:\nBandage scissors\nIris scissors\nMayo scissors\nMetzenbaum scissors\nTenotomy scissors\nOther:\nRongeur\nCurette\nOsteotome\nDrill bits\nRasps\nTrocars\nDrills\nCranial drills\nDental drills\nDermatomes\nGrasping (forceps)\nBulldogs forceps\nHemostat\nObstetric\nVulsellum\nTenaculum\nDebakey forceps\nClamping\nFoerster clamp\nHemostat\nPennington clamp\nAortic cross-clamp\nGomco clamp\nAllis clamp\nRetracting\/viewing\nRetractors: Senn retractor\nRib spreader\nAccessory\/otherExamination\/prep:\nDilators\nSpecula\nFiber optic endoscopes\nHead mirror\nSuction:\nYankauer suction tip\n\nIrrigation and injection needles\nMeasurement devices:\nrulers and calipers\nDrain:\nJackson-Pratt drain\nPenrose drain\nOther:\nSurgical staplers\nPeriodontal probe\nSurgical suture\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Dermatome_(instrument)\">https:\/\/www.limswiki.org\/index.php\/Dermatome_(instrument)<\/a>\n\t\t\t\t\tCategories: Medical devicesSurgical instrumentsHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest 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\r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:50.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 915 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","053eab61e093aea2255f4b96741fb09f_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Dermatome_instrument skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Dermatome (instrument)<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dermatome_(disambiguation)\" class=\"mw-redirect mw-disambig\" title=\"Dermatome (disambiguation)\" rel=\"external_link\" target=\"_blank\">Dermatome<\/a>.<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:172px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermatome.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/09\/Dermatome.png\/170px-Dermatome.png\" width=\"170\" height=\"333\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermatome.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Diagram of a dermatome<\/div><\/div><\/div>\n<p>A <b>dermatome<\/b> is a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_instrument\" title=\"Surgical instrument\" rel=\"external_link\" target=\"_blank\">surgical instrument<\/a> used to produce thin slices of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin\" title=\"Skin\" rel=\"external_link\" target=\"_blank\">skin<\/a> from a donor area, in order to use them for making <a href=\"https:\/\/en.wikipedia.org\/wiki\/Skin_graft\" class=\"mw-redirect\" title=\"Skin graft\" rel=\"external_link\" target=\"_blank\">skin grafts<\/a>. One of its main applications is for reconstituting skin areas damaged by grade 3 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Burn_(injury)\" class=\"mw-redirect\" title=\"Burn (injury)\" rel=\"external_link\" target=\"_blank\">burns<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/Physical_trauma\" class=\"mw-redirect\" title=\"Physical trauma\" rel=\"external_link\" target=\"_blank\">trauma<\/a>.\n<\/p><p>Dermatomes can be operated either manually or electrically. The first drum dermatomes, developed in the 1930s, were manually operated. Afterwards, dermatomes which were operated by air pressure, such as the Brown dermatome, achieved higher speed and precision. Electrical dermatomes are better for cutting out thinner and longer strips of skin with a more homogeneous thickness.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Free-hand_knives\">Free-hand knives<\/span><\/h2>\n<p>Those are manual dermatomes and the term <i>knife<\/i> or <i>scalpel<\/i> is used to describe them. Their disadvantages are harvesting of grafts with irregular edges and grafts of variable thickness. Their operator has to be experienced in their use for optimal results.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types_of_dermatomes\">Types of dermatomes<\/span><\/h2>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:202px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermatome_usage.png\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/35\/Dermatome_usage.png\/200px-Dermatome_usage.png\" width=\"200\" height=\"108\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dermatome_usage.png\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Side view of a drum dermatome blade (24) removing a slice of skin (38 and 40).<\/div><\/div><\/div>\n<p>There are several types of dermatomes, usually named after their inventor.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Knives\">Knives<\/span><\/h3>\n<ul><li><b>Blair\/Brown knife<\/b>.<\/li>\n<li><b>Humby knife<\/b>, similar to the Blair knife with the addition of an adjustable roller which controls the thickness of the graft taken.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup><\/li>\n<li><b>Braithwaite knife<\/b>.<\/li>\n<li><b>Watson knife<\/b>, another modified version of the Braithwaite knife.<\/li>\n<li><b>Cobbett knife<\/b>, a modified version of the Braithwaite knife.<\/li>\n<li><b>Goulian\/Weck knife<\/b>.<\/li>\n<li><b>Silver knife<\/b>, ideal for the harvesting of small grafts.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Drum\">Drum<\/span><\/h3>\n<ul><li><b>Padgett dermatome<\/b>, was the first rotary drum manual dermatome to be devised.<\/li>\n<li><b>Reese dermatome<\/b>.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Electric\">Electric<\/span><\/h3>\n<ul><li><b>Brown dermatome<\/b>, the first with powered rotation to be developed, used mostly for large skin grafts. It is electrically operated.<\/li>\n<li><b>Castroviejo dermatome<\/b>, also electrically operated, is a precision dermatome with a small head and controllable thickness, which is most used for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mucous_membrane\" title=\"Mucous membrane\" rel=\"external_link\" target=\"_blank\">mucous membrane<\/a> grafts.<\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Air\">Air<\/span><\/h3>\n<ul><li><b>Air dermatome<\/b>, the most commonly used dermatome used worldwide today, used mostly for large skin grafts.<sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Instruments_used_in_general_surgery\" title=\"Instruments used in general surgery\" rel=\"external_link\" target=\"_blank\">Instruments used in general surgery<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap\"><ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">David L. Brown, Gregory H. Borschel, <i>Michigan Manual of Plastic Surgery<\/i><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Ian A. McGregor, <i>Fundamental Techniques of Plastic Surgery and Their Surgical Applications<\/i><\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"> <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=true\">\"Tiny Air Turbines Drive Surgical Instruments..\"<\/a> <i>Popular Science<\/i>, September 1966, pp. 82-83.<\/span>\n<\/li>\n<\/ol><\/div><\/div>\n\n<p><!-- \nNewPP limit report\nParsed by mw1325\nCached time: 20181127220247\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.088 seconds\nReal time usage: 0.122 seconds\nPreprocessor visited node count: 268\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 25231\/2097152 bytes\nTemplate argument size: 86\/2097152 bytes\nHighest expansion depth: 7\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 1238\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\nLua time usage: 0.019\/10.000 seconds\nLua memory usage: 1,019 KB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 70.582 1 -total\n<\/p>\n<pre>41.16% 29.054 1 Template:Other_uses\n32.66% 23.054 3 Template:Navbox\n32.19% 22.720 1 Template:Surgical_instruments\n22.82% 16.108 1 Template:Reflist\n 5.33% 3.765 1 Template:Main_other\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1465659-1!canonical and timestamp 20181127220247 and revision id 768605767\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dermatome_%28instrument%29\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214653\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.011 seconds\nReal time usage: 0.158 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 152.074 1 - wikipedia:Dermatome_(instrument)\n100.00% 152.074 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8554-0!*!*!*!*!*!* and timestamp 20181217214653 and revision id 24982\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Dermatome_(instrument)\">https:\/\/www.limswiki.org\/index.php\/Dermatome_(instrument)<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","053eab61e093aea2255f4b96741fb09f_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/0\/09\/Dermatome.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/35\/Dermatome_usage.png\/400px-Dermatome_usage.png"],"053eab61e093aea2255f4b96741fb09f_timestamp":1545083213,"5bd64ab04b9fb048ddfb3cd4ff215fac_type":"article","5bd64ab04b9fb048ddfb3cd4ff215fac_title":"Calipers","5bd64ab04b9fb048ddfb3cd4ff215fac_url":"https:\/\/www.limswiki.org\/index.php\/Calipers","5bd64ab04b9fb048ddfb3cd4ff215fac_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tCalipers\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tFor other uses, see Caliper (disambiguation).\n Caliper detail view\nA caliper (British spelling also calliper, or in plurale tantum sense a pair of calipers) is a device used to measure the distance between two opposite sides of an object. Many types of calipers permit reading out a measurement on a ruled scale, a dial, or a digital display. But a caliper can be as simple as a compass with inward or outward-facing points. The tips of the caliper are adjusted to fit across the points to be measured and then the caliper is then removed and the distance read by measuring between the tips with a measuring tool, such as a ruler.\nIt is used in many fields such as mechanical engineering, metalworking, forestry, woodworking, science and medicine.\n\nContents \n\n1 Nomenclature variants \n2 History \n3 Types \n\n3.1 Inside caliper \n3.2 Outside caliper \n3.3 Divider caliper \n3.4 Oddleg caliper \n3.5 Vernier caliper \n3.6 Dial caliper \n3.7 Digital caliper \n3.8 Micrometer caliper \n\n\n4 Comparison \n5 Use \n6 Zero error \n7 See also \n8 References \n9 External links \n\n\nNomenclature variants \nA plurale tantum sense of the word \"calipers\" coexists in natural usage with the regular noun sense of \"caliper\". That is, sometimes a caliper is treated cognitively like a pair of glasses or a pair of scissors, resulting in a phrase such as \"hand me those calipers\" or \"those calipers are mine\" in reference to one unit.\nAlso existing colloquially but not in formal usage is referring to a vernier caliper as a \"vernier\" or a \"pair of verniers\". In imprecise colloquial usage, some speakers extend this even to dial calipers, although they involve no vernier scale.\nIn machine-shop usage, the term \"caliper\" is often used in contradistinction to \"micrometer\", even though outside micrometers are technically a form of caliper. In this usage, \"caliper\" implies only the form factor of the vernier or dial caliper (or its digital counterpart).\n\nHistory \nThe earliest caliper has been found in the Greek Giglio wreck near the Italian coast. The ship find dates to the 6th century BC. The wooden piece already featured a fixed and a movable jaw.[1][2] Although rare finds, caliper remained in use by the Greeks and Romans.[2][3]\nA bronze caliper, dating from 9 AD, was used for minute measurements during the Chinese Xin dynasty. The caliper had an inscription stating that it was \"made on a gui-you day at new moon of the first month of the first year of the Shijian guo period.\" The calipers included a \"slot and pin\" and \"graduated in inches and tenths of an inch.\"[4][5]\n\n Caliper with graduated bow 0\u201310 mm\nThe modern vernier caliper, reading to thousandths of an inch, was invented by American Joseph R. Brown in 1851. It was the first practical tool for exact measurements that could be sold at a price within the reach of ordinary machinists.[6]\n\nTypes \nInside caliper \n Two inside calipers\nThe inside calipers are used to measure the internal size of an object.\n\nThe upper caliper in the image (at the right) requires manual adjustment prior to fitting. Fine setting of this caliper type is performed by tapping the caliper legs lightly on a handy surface until they will almost pass over the object. A light push against the resistance of the central pivot screw then spreads the legs to the correct dimension and provides the required, consistent feel that ensures a repeatable measurement.\nThe lower caliper in the image has an adjusting screw that permits it to be carefully adjusted without removal of the tool from the workpiece. \nOutside caliper \n Three outside calipers.\nOutside calipers are used to measure the external size of an object.\nThe same observations and technique apply to this type of caliper, as for the above inside caliper. With some understanding of their limitations and usage, these instruments can provide a high degree of accuracy and repeatability. They are especially useful when measuring over very large distances; consider if the calipers are used to measure a large diameter pipe. A vernier caliper does not have the depth capacity to straddle this large diameter while at the same time reach the outermost points of the pipe's diameter. They are made from high carbon steel.\n\n\nDivider caliper \nMain article: Compass (drafting)\n A pair of dividers\nIn the metalworking field, a divider caliper, popularly called a compass, is used in the process of marking out locations. The points are sharpened so that they act as scribers, one leg can then be placed in the dimple created by a center or prick punch and the other leg pivoted so that it scribes a line on the workpiece's surface, thus forming an arc or circle.\nA divider caliper is also used to measure a distance between two points on a map. The two caliper's ends are brought to the two points whose distance is being measured. The caliper's opening is then either measured on a separate ruler and then converted to the actual distance, or it is measured directly on a scale drawn on the map. On a nautical chart the distance is often measured on the latitude scale appearing on the sides of the map: one minute of arc of latitude is approximately one nautical mile or 1852 metres.\nDividers are also used in the medical profession. An ECG (also EKG) caliper transfers distance on an electrocardiogram; in conjunction with the appropriate scale, the heart rate can be determined. A pocket caliper versions was invented by cardiologist Robert A. Mackin.[7]\n\nOddleg caliper \n Oddleg calipers\nOddleg calipers, Hermaphrodite calipers, or Oddleg jennys, as pictured on the left, are generally used to scribe a line at a set distance from the edge of a workpiece. The bent leg is used to run along the workpiece edge while the scriber makes its mark at a predetermined distance, this ensures a line parallel to the edge.\nIn the diagram at left, the uppermost caliper has a slight shoulder in the bent leg allowing it to sit on the edge more securely, the lower caliper lacks this feature but has a renewable scriber that can be adjusted for wear, as well as being replaced when excessively worn.\n\n\nVernier caliper \nMain article: Vernier scale\n Diagram of Vernier calipers. The labeled parts are Outside large jaws: used to measure external diameter or width of an objectInside small jaws: used to measure internal diameter of an objectDepth probe\/rod: used to measure depths of an object or a holeMain scale (Metric): scale marked every mmMain scale (Imperial): scale marked in inches and fractionsVernier scale (Metric) gives interpolated measurements to 0.1 mm or betterVernier scale (Imperial) gives interpolated measurements in fractions of an inchRetainer: used to block movable part to allow the easy transferring of a measurement The calipers in the diagram show a primary reading on the metric scale of about 2.475 cm (2.4 cm read from the main scale plus about 0.075 cm from the Vernier scale). Calipers often have a \"zero point error\", which is when the calipers do not read 0.000 cm when the jaws are closed. The zero point error must always be subtracted from the primary reading. Let us assume these calipers have a zero point error of 0.013 cm. This would give us a length reading of 2.462 cm. For any measurement, reporting the error on the measurement is also important. Both the primary reading and the zero point reading are bounded by plus\/minus half the length corresponding to the width of the smallest interval on the Vernier scale (0.0025 cm). These are \"absolute\" errors and absolute errors add, so the length reading is then bounded by plus\/minus the length corresponding to the full width of the smallest interval on the Vernier scale (0.005 cm). Assuming no systematics affect the measurement (the instrument works perfectly), a complete measurement would then read 2.462 cm \u00b1 0.005 cm.\nThe vernier, dial, and digital calipers give a direct reading of the distance measured with high accuracy and precision. They are functionally identical, with different ways of reading the result. These calipers comprise a calibrated scale with a fixed jaw, and another jaw, with a pointer, that slides along the scale. The distance between the jaws is then read in different ways for the three types.\nThe simplest method is to read the position of the pointer directly on the scale. When the pointer is between two markings, the user can mentally interpolate to improve the precision of the reading. This would be a simple calibrated caliper; but the addition of a vernier scale allows more accurate interpolation, and is the universal practice; this is the vernier caliper.\nVernier, dial, and digital calipers can measure internal dimensions (using the uppermost jaws in the picture at right), external dimensions using the pictured lower jaws, and in many cases depth by the use of a probe that is attached to the movable head and slides along the centre of the body. This probe is slender and can get into deep grooves that may prove difficult for other measuring tools.\nThe vernier scales may include metric measurements on the lower part of the scale and inch measurements on the upper, or vice versa, in countries that use inches. Vernier calipers commonly used in industry provide a precision to 0.01 mm (10 micrometres), or one thousandth of an inch. They are available in sizes that can measure up to 1,829 mm (72 in).[8]\n\n\nDial caliper \n Mitutoyo dial caliper\nInstead of using a vernier mechanism, which requires some practice to use, the dial caliper reads the final fraction of a millimeter or inch on a simple dial.\nIn this instrument, a small, precise rack and pinion drives a pointer on a circular dial, allowing direct reading without the need to read a vernier scale. Typically, the pointer rotates once every inch, tenth of an inch, or 1 millimeter. This measurement must be added to the coarse whole inches or centimeters read from the slide. The dial is usually arranged to be rotatable beneath the pointer, allowing for \"differential\" measurements (the measuring of the difference in size between two objects, or the setting of the dial using a master object and subsequently being able to read directly the plus-or-minus variance in size of subsequent objects relative to the master object).\nThe slide of a dial caliper can usually be locked at a setting using a small lever or screw; this allows simple go\/no-go checks of part sizes.\n\nDigital caliper \n Digital caliper\nA popular refinement replaces the analog dial with an electronic digital display that displays the reading as a numeric value. Rather than a rack and pinion, these calipers use a linear encoder. Some digital calipers can be switched between centimeters or millimeters, and inches. All provide for zeroing the display at any point along the slide, allowing the same sort of differential measurements as with the dial caliper. Digital calipers may contain a \"reading hold\" feature, allowing the reading of dimensions after use in awkward locations where the display cannot be seen.\nOrdinary 6-in\/150-mm digital calipers are made of stainless steel, have a rated accuracy of 0.001 in (0.02mm) and a resolution of 0.0005 in (0.01 mm).[9]\nThe same technology is used to make longer 8-in and 12-in calipers; the accuracy for longer measurements declines to 0.001 in (0.03 mm) for 100\u2013200 mm and 0.0015 in (0.04 mm) for 200\u2013300 mm.[10]\nIncreasingly, digital calipers offer a serial data output to allow them to be interfaced with a dedicated recorder or a personal computer. The digital interface significantly decreases the time to make and record a series of measurements, and it also improves the reliability of the records. A suitable device to convert the serial data output to common computer interfaces such as RS-232, Universal Serial Bus, or wireless can be built or purchased. With such a converter, measurements can be directly entered into a spreadsheet, a statistical process control program, or similar software.\nThe serial digital output varies among manufacturers. Common options are\n\nMitutoyo's Digimatic interface. This is the dominant name brand interface. Format is 52 bits arranged as 13 nibbles.[11][12][13]\nSylvac interface. This is the common protocol for inexpensive, non-name brand, calipers. Format is 24 bit 90 kHz synchronous.[14][15]\nStarrett[16]\nBrown & Sharpe[16]\nFederal\nTesa[16]\nAldi. Format is 7 BCD digits.[15]\nMahr (Digimatic, RS232C, Wireless FM Radio, Infrared and USB)[17]\nLike dial calipers, the slide of a digital caliper can usually be locked using a lever or thumb-screw.\nSome digital calipers contain a capacitive linear encoder. A pattern of bars is etched directly on the printed circuit board in the slider. Under the scale of the caliper another printed circuit board also contains an etched pattern of lines. The combination of these printed circuit boards forms two variable capacitors. The two capacitances are out of phase. As the slider moves the capacitance changes in a linear fashion and in a repeating pattern. The circuitry built into the slider counts the bars as the slider moves and does a linear interpolation based on the magnitudes of the capacitors to find the precise position of the slider. Other digital calipers contain an inductive linear encoder, which allows robust performance in the presence of contamination such as coolants.[18] Magnetic linear encoders are used in yet other digital calipers.\n\n\nMicrometer caliper \nMain article: Micrometer\nA caliper using a calibrated screw for measurement, rather than a slide, is called an external micrometer caliper gauge, a micrometer caliper or, more often, simply a micrometer. (Sometimes the term caliper, referring to any other type in this article, is held in contradistinction to micrometer.)\n\nComparison \nEach of the above types of calipers has its relative merits and faults.\nVernier calipers are rugged and have long lasting accuracy, are coolant proof, are not affected by magnetic fields, and are largely shock proof. They may have both centimeter and inch scales. However, vernier calipers require good eyesight or a magnifying glass to read and can be difficult to read from a distance or from awkward angles. It is relatively easy to misread the last digit. In production environments, reading vernier calipers all day long is error-prone and is annoying to the workers.\nDial calipers are comparatively easy to read, especially when seeking exact center by rocking and observing the needle movement. They can be set to 0 at any point for comparisons. They are usually fairly susceptible to shock damage. They are also very prone to getting dirt in the gears, which can cause accuracy problems.\nDigital calipers switch easily between centimeter and inch systems.They can be set to 0 easily at any point with full count in either direction, and can take measurements even if the display is completely hidden, either by using a \"hold\" key, or by zeroing the display and closing the jaws, showing the correct measurement, but negative. They can be mechanically and electronically fragile. Most also require batteries, and do not resist coolant well. They are also only moderately shockproof, and can be vulnerable to dirt.\nCalipers may read to a resolution of 0.01 mm or 0.0005 in, but accuracy may not be better than about \u00b10.02 mm or 0.001 in for 150 mm (6 in) calipers, and worse for longer ones.[19]\n\nUse \n Using the vernier caliper\nA caliper must be properly applied against the part in order to take the desired measurement. For example, when measuring the thickness of a plate a vernier caliper must be held at right angles to the piece. Some practice may be needed to measure round or irregular objects correctly.\nAccuracy of measurement when using a caliper is highly dependent on the skill of the operator. Regardless of type, a caliper's jaws must be forced into contact with the part being measured. As both part and caliper are always to some extent elastic, the amount of force used affects the indication. A consistent, firm touch is correct. Too much force results in an underindication as part and tool distort; too little force gives insufficient contact and an overindication. This is a greater problem with a caliper incorporating a wheel, which lends mechanical advantage. This is especially the case with digital calipers, calipers out of adjustment, or calipers with a poor quality beam.\nSimple calipers are uncalibrated; the measurement taken must be compared against a scale. Whether the scale is part of the caliper or not, all analog calipers\u2014verniers and dials\u2014require good eyesight in order to achieve the highest precision. Digital calipers have the advantage in this area.\nCalibrated calipers may be mishandled, leading to loss of zero. When a calipers' jaws are fully closed, it should, of course, indicate zero. If it does not, it must be recalibrated or repaired. A vernier caliper does not easily lose its calibration but a sharp impact or accidental damage to the measuring surface in the caliper jaw can be significant enough to displace zero.[20] Digital calipers have zero set buttons, for quick recalibration.\nVernier, dial and digital calipers can be used with accessories that extend their usefulness. Examples are a base that extends their usefulness as a depth gauge and a jaw attachment that allows measuring the center distance between holes. Since the 1970s a clever modification of the moveable jaw on the back side of any caliper allows for step or depth measurements in addition to external caliper measurements, in similar fashion to a universal micrometer (e.g., Starrett Mul-T-Anvil or Mitutoyo Uni-Mike).\n\nZero error \n When the jaws are closed and if the reading is 0.10 mm, the zero error is referred to as +0.10 mm. The method to use a vernier scale or caliper with zero error is to use the formula \"(actual reading) = (main scale) + (vernier scale) \u2212 (zero error)\", thus the actual reading is 19.00 + 0.54 \u2212 (0.10) = 19.44 mm. The resolution of the measurement, based on the width of the smallest sub-interval, is \u00b10.02 mm.\nThe method to use a vernier scale or caliper with zero error is to use the formula \"actual reading = main scale + vernier scale \u2212 (zero error)\". Zero error may arise due to knocks that affect the calibration at 0.00 mm when the jaws are perfectly closed or just touching each other. Positive zero error refers to the fact that when the jaws of the vernier caliper are just closed, the reading is a positive reading away from the actual reading of 0.00 mm. If the reading is 0.10 mm, the zero error is referred to as +0.10 mm. Negative zero error refers to the fact that when the jaws of the vernier caliper are just closed, the reading is a negative reading away from the actual reading of 0.00 mm. If the reading is \u22120.08 mm, the zero error is referred to as \u22120.08 mm.\n\nSee also \nDial indicator\nCruising rod\nLens clock\nReferences \n\n\n^ Mensun Bound: The Giglio wreck: a wreck of the Archaic period (c. 600 BC) off the Tuscany island of Giglio, Hellenic Institute of Marine Archaeology, Athens 1991, pp. 27 and 31 (Fig. 65) \n\n^ a b Roger B. Ulrich: Roman woodworking, Yale University Press, New Haven, Conn., 2007, ISBN 0-300-10341-7, p.52f. \n\n^ \"hand tool.\" Encyclop\u00e6dia Britannica from Encyclop\u00e6dia Britannica 2006 Ultimate Reference Suite DVD. [Accessed July 29, 2008] \n\n^ Colin A. Ronan; Joseph Needham (24 June 1994). The Shorter Science and Civilisation in China: 4. Cambridge University Press. p. 36. ISBN 978-0-521-32995-8. adjustable outside caliper gauge... self-dated at AD 9 . An abridged version. \n\n^ \"Archived copy\". Archived from the original on 2014-08-31. Retrieved 2013-11-26 . CS1 maint: Archived copy as title (link) \n\n^ Joseph Wickham Roe, English and American tool builders (1916) p. 203 \n\n^ http:\/\/www.mackinmfg.com\/ shows a picture of the calipers but does not support the RAM claim. \n\n^ \"Archived copy\" (PDF) . Archived from the original (PDF) on 2010-05-25. Retrieved 2010-06-25 . CS1 maint: Archived copy as title (link) \n\n^ \"Harbor Freight Tools \u2013 Quality Tools at Discount Prices Since 1977\". www.harborfreight.com. \n\n^ \"Archived copy\". Archived from the original on 2007-07-26. Retrieved 2009-06-12 . CS1 maint: Archived copy as title (link) \n\n^ DRO System: Linear Scales & Counters (PDF) , Mitutoyo, n.d., p. 22, Bulletin No. 1715, archived from the original (PDF) on 2013-11-03 \n\n^ Linear Gage (PDF) , Mitutoyo, n.d., p. 33, Catalog No. E4174-542\/572\/575, archived from the original (PDF) on 2013-11-03 \n\n^ Lancaster, Don (February 2000), \"Tech Musings\" (PDF) , Tech Musings, 145 \n\n^ \"Chinese Scales\". www.shumatech.com. \n\n^ a b Yadro archive-date=2013-12-09 archive-url=https:\/\/web.archive.org\/web\/20131209053512\/http:\/\/yadro.de\/digital-scale\/protocol.html \n\n^ a b c Lancaster, Don (November 1999), \"Tech Musings\" (PDF) , Tech Musings, 142: 142.3 \n\n^ \"New Mahr 2015 Catalogue\". www.Cutwel.co.uk. Cutwel. \n\n^ ABS Coolant Proof Caliper; Coolant Proof Micrometer (PDF) , Mitutoyo, January 2005, Bulletin No. 1813-293\/500, archived from the original (PDF) on 2013-11-03 \n\n^ \"Accuracy of Calipers\". www.tresnainstrument.com. \n\n^ Mitutoyo. E 12024 Check Points For Measuring Instruments. pp. 2, 3. \n\n\nExternal links \n\n\n\nWikimedia Commons has media related to Calipers.\nRS-232 Interface Design Details For Digital Caliper\nvteMetalworkingvteToolsCutting machines\nBandsaw\nCold saw\nLaser\nMiter saw\nPlasma\nWater jet cutter\nCutting tools\nBroach\nBurr\nChisel\nCounterbore\nCountersink\nEnd mill\nFile\nHand scraper\nMilling cutter\nNibbler\nReamer\nShears\nTipped tool\nTool bit\nForming tools\nBrake\nDie\nEnglish wheel\nHydraulic press\nMachine press\nPunch press\nScrew press\nStamping press\nHand tools\nClamp\nCombination square\nDrift pin\nHacksaw\nHammer\nHand scraper\nMachinist square\nNeedlegun scaler\nPiercing saw\nPliers\nPunch\nScriber\nTap and die\nTongs\nVise\nWorkbench\nWrench\nMachine tooling\nAngle plate\nChuck\nCollet\nFixture\nIndexing head\nJig\nLathe center\nMachine taper\nMagnetic base\nMandrel\nRotary table\nWiggler\nMeasuring instruments\nBore gauge\nCaliper\nCenter gauge\nDial 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\r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 8 April 2016, at 19:47.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 680 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","5bd64ab04b9fb048ddfb3cd4ff215fac_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Calipers skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Calipers<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div role=\"note\" class=\"hatnote navigation-not-searchable\">For other uses, see <a href=\"https:\/\/en.wikipedia.org\/wiki\/Caliper_(disambiguation)\" class=\"mw-disambig\" title=\"Caliper (disambiguation)\" rel=\"external_link\" target=\"_blank\">Caliper (disambiguation)<\/a>.<\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Caliper_detail_view.jpeg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/18\/Caliper_detail_view.jpeg\/220px-Caliper_detail_view.jpeg\" width=\"220\" height=\"137\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Caliper_detail_view.jpeg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Caliper detail view<\/div><\/div><\/div>\n<p>A <b>caliper<\/b> (<a href=\"https:\/\/en.wikipedia.org\/wiki\/American_and_British_English_spelling_differences\" title=\"American and British English spelling differences\" rel=\"external_link\" target=\"_blank\">British spelling<\/a> also <b>calliper<\/b>, or in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plurale_tantum\" title=\"Plurale tantum\" rel=\"external_link\" target=\"_blank\">plurale tantum<\/a> sense <b>a pair of calipers<\/b>) is a device used to <a href=\"https:\/\/en.wikipedia.org\/wiki\/Measurement\" title=\"Measurement\" rel=\"external_link\" target=\"_blank\">measure<\/a> the distance between two opposite sides of an object. Many types of calipers permit reading out a measurement on a ruled scale, a dial, or a digital display. But a caliper can be as simple as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compass_(drafting)\" class=\"mw-redirect\" title=\"Compass (drafting)\" rel=\"external_link\" target=\"_blank\">compass<\/a> with inward or outward-facing points. The tips of the caliper are adjusted to fit across the points to be measured and then the caliper is then removed and the distance read by measuring between the tips with a measuring tool, such as a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ruler\" title=\"Ruler\" rel=\"external_link\" target=\"_blank\">ruler<\/a>.\n<\/p><p>It is used in many fields such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mechanical_engineering\" title=\"Mechanical engineering\" rel=\"external_link\" target=\"_blank\">mechanical engineering<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metalworking\" title=\"Metalworking\" rel=\"external_link\" target=\"_blank\">metalworking<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Forestry\" title=\"Forestry\" rel=\"external_link\" target=\"_blank\">forestry<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Woodworking\" title=\"Woodworking\" rel=\"external_link\" target=\"_blank\">woodworking<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Science\" title=\"Science\" rel=\"external_link\" target=\"_blank\">science<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Medicine\" title=\"Medicine\" rel=\"external_link\" target=\"_blank\">medicine<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Nomenclature_variants\">Nomenclature variants<\/span><\/h2>\n<p>A <a href=\"https:\/\/en.wikipedia.org\/wiki\/Plurale_tantum\" title=\"Plurale tantum\" rel=\"external_link\" target=\"_blank\">plurale tantum<\/a> sense of the word \"calipers\" coexists in natural usage with the regular noun sense of \"caliper\". That is, sometimes a caliper is treated cognitively like a pair of glasses or a pair of scissors, resulting in a phrase such as \"hand me those calipers\" or \"those calipers are mine\" in reference to one unit.\n<\/p><p>Also existing colloquially but not in formal usage is referring to a vernier caliper as a \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Vernier_scale\" title=\"Vernier scale\" rel=\"external_link\" target=\"_blank\">vernier<\/a>\" or a \"pair of verniers\". In imprecise colloquial usage, some speakers extend this even to dial calipers, although they involve no vernier scale.\n<\/p><p>In machine-shop usage, the term \"caliper\" is often used in contradistinction to \"<a href=\"https:\/\/en.wikipedia.org\/wiki\/Micrometer\" title=\"Micrometer\" rel=\"external_link\" target=\"_blank\">micrometer<\/a>\", even though outside micrometers are technically a form of caliper. In this usage, \"caliper\" implies only the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Design\" title=\"Design\" rel=\"external_link\" target=\"_blank\">form factor<\/a> of the vernier or dial caliper (or its digital counterpart).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"History\">History<\/span><\/h2>\n<p>The earliest caliper has been found in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Greece\" title=\"Ancient Greece\" rel=\"external_link\" target=\"_blank\">Greek<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Giglio_Island\" class=\"mw-redirect\" title=\"Giglio Island\" rel=\"external_link\" target=\"_blank\">Giglio<\/a> wreck near the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Italy\" title=\"Italy\" rel=\"external_link\" target=\"_blank\">Italian<\/a> coast. The ship find dates to the 6th century BC. The wooden piece already featured a fixed and a movable jaw.<sup id=\"rdp-ebb-cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\" rel=\"external_link\">[1]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-Roger_B._Ulrich_2-0\" class=\"reference\"><a href=\"#cite_note-Roger_B._Ulrich-2\" rel=\"external_link\">[2]<\/a><\/sup> Although rare finds, caliper remained in use by the Greeks and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Ancient_Rome\" title=\"Ancient Rome\" rel=\"external_link\" target=\"_blank\">Romans<\/a>.<sup id=\"rdp-ebb-cite_ref-Roger_B._Ulrich_2-1\" class=\"reference\"><a href=\"#cite_note-Roger_B._Ulrich-2\" rel=\"external_link\">[2]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-3\" class=\"reference\"><a href=\"#cite_note-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p><p>A bronze caliper, dating from 9 AD, was used for minute measurements during the Chinese <a href=\"https:\/\/en.wikipedia.org\/wiki\/Xin_dynasty\" title=\"Xin dynasty\" rel=\"external_link\" target=\"_blank\">Xin dynasty<\/a>. The caliper had an inscription stating that it was \"made on a <i>gui-you<\/i> day at new moon of the first month of the first year of the Shijian guo period.\" The calipers included a \"slot and pin\" and \"graduated in inches and tenths of an inch.\"<sup id=\"rdp-ebb-cite_ref-Ronan_4-0\" class=\"reference\"><a href=\"#cite_note-Ronan-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\" rel=\"external_link\">[5]<\/a><\/sup>\n<\/p>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Calibro_archetto_graduato.JPG\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/73\/Calibro_archetto_graduato.JPG\/220px-Calibro_archetto_graduato.JPG\" width=\"220\" height=\"148\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Calibro_archetto_graduato.JPG\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Caliper with graduated bow 0\u201310 mm<\/div><\/div><\/div>\n<p>The modern vernier caliper, reading to thousandths of an inch, was invented by American Joseph R. Brown in 1851. It was the first practical tool for exact measurements that could be sold at a price within the reach of ordinary machinists.<sup id=\"rdp-ebb-cite_ref-6\" class=\"reference\"><a href=\"#cite_note-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Types\">Types<\/span><\/h2>\n<h3><span class=\"mw-headline\" id=\"Inside_caliper\">Inside caliper<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:InsideCalipers.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c3\/InsideCalipers.jpg\/220px-InsideCalipers.jpg\" width=\"220\" height=\"157\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:InsideCalipers.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Two inside calipers<\/div><\/div><\/div>\n<p>The <b>inside calipers<\/b> are used to measure the internal size of an object.\n<\/p>\n<ul><li>The upper caliper in the image (at the right) requires manual adjustment prior to fitting. Fine setting of this caliper type is performed by tapping the caliper legs lightly on a handy surface until they will <i>almost<\/i> pass over the object. A light push against the resistance of the central pivot screw then spreads the legs to the correct dimension and provides the required, consistent <i>feel<\/i> that ensures a repeatable measurement.<\/li>\n<li>The lower caliper in the image has an adjusting screw that permits it to be carefully adjusted without removal of the tool from the workpiece. <div style=\"clear:both;\"><\/div><\/li><\/ul>\n<h3><span class=\"mw-headline\" id=\"Outside_caliper\">Outside caliper<\/span><\/h3>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:OutsideCalipers.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/OutsideCalipers.jpg\/220px-OutsideCalipers.jpg\" width=\"220\" height=\"159\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:OutsideCalipers.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Three outside calipers.<\/div><\/div><\/div>\n<p><b>Outside calipers<\/b> are used to measure the external size of an object.\n<\/p><p>The same observations and technique apply to this type of caliper, as for the above inside caliper. With some understanding of their limitations and usage, these instruments can provide a high degree of accuracy and repeatability. They are especially useful when measuring over very large distances; consider if the calipers are used to measure a large diameter pipe. A vernier caliper does not have the depth capacity to straddle this large diameter while at the same time reach the outermost points of the pipe's diameter. They are made from high carbon steel.\n<\/p>\n<div style=\"clear:both;\"><\/div>\n<h3><span class=\"mw-headline\" id=\"Divider_caliper\">Divider caliper<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Compass_(drafting)\" class=\"mw-redirect\" title=\"Compass (drafting)\" rel=\"external_link\" target=\"_blank\">Compass (drafting)<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:DividerCalipers.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/DividerCalipers.jpg\/220px-DividerCalipers.jpg\" width=\"220\" height=\"122\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:DividerCalipers.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>A pair of dividers<\/div><\/div><\/div>\n<p>In the metalworking field, a <b>divider caliper,<\/b> popularly called a <b>compass,<\/b> is used in the process of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Marking_out\" title=\"Marking out\" rel=\"external_link\" target=\"_blank\">marking out<\/a> locations. The points are sharpened so that they act as scribers, one leg can then be placed in the dimple created by a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Punch_(engineering)\" class=\"mw-redirect\" title=\"Punch (engineering)\" rel=\"external_link\" target=\"_blank\">center or prick punch<\/a> and the other leg pivoted so that it scribes a line on the workpiece's surface, thus forming an arc or circle.\n<\/p><p>A divider caliper is also used to measure a distance between two points on a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Map\" title=\"Map\" rel=\"external_link\" target=\"_blank\">map<\/a>. The two caliper's ends are brought to the two points whose distance is being measured. The caliper's opening is then either measured on a separate ruler and then converted to the actual distance, or it is measured directly on a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Scale_(map)\" title=\"Scale (map)\" rel=\"external_link\" target=\"_blank\">scale<\/a> drawn on the map. On a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nautical_chart\" title=\"Nautical chart\" rel=\"external_link\" target=\"_blank\">nautical chart<\/a> the distance is often measured on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Latitude\" title=\"Latitude\" rel=\"external_link\" target=\"_blank\">latitude<\/a> scale appearing on the sides of the map: one minute of arc of latitude is approximately one <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nautical_mile\" title=\"Nautical mile\" rel=\"external_link\" target=\"_blank\">nautical mile<\/a> or 1852 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metre\" title=\"Metre\" rel=\"external_link\" target=\"_blank\">metres<\/a>.\n<\/p><p>Dividers are also used in the medical profession. An ECG (also EKG) caliper transfers distance on an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electrocardiogram\" class=\"mw-redirect\" title=\"Electrocardiogram\" rel=\"external_link\" target=\"_blank\">electrocardiogram<\/a>; in conjunction with the appropriate scale, the heart rate can be determined. A pocket caliper versions was invented by cardiologist Robert A. Mackin.<sup id=\"rdp-ebb-cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Oddleg_caliper\">Oddleg caliper<\/span><\/h3>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:OddlegCalipers.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/83\/OddlegCalipers.jpg\/220px-OddlegCalipers.jpg\" width=\"220\" height=\"131\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:OddlegCalipers.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Oddleg calipers<\/div><\/div><\/div>\n<p><b>Oddleg calipers<\/b>, <b>Hermaphrodite calipers<\/b>, or <b>Oddleg jennys<\/b>, as pictured on the left, are generally used to scribe a line at a set distance from the edge of a workpiece. The bent leg is used to run along the workpiece edge while the scriber makes its mark at a predetermined distance, this ensures a line parallel to the edge.\n<\/p><p>In the diagram at left, the uppermost caliper has a slight shoulder in the bent leg allowing it to sit on the edge more securely, the lower caliper lacks this feature but has a renewable scriber that can be adjusted for wear, as well as being replaced when excessively worn.\n<\/p>\n<div style=\"clear:both;\"><\/div>\n<h3><span class=\"mw-headline\" id=\"Vernier_caliper\">Vernier caliper<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vernier_scale\" title=\"Vernier scale\" rel=\"external_link\" target=\"_blank\">Vernier scale<\/a><\/div>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:602px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vernier_caliper.svg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f6\/Vernier_caliper.svg\/600px-Vernier_caliper.svg.png\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vernier_caliper.svg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Diagram of Vernier calipers. The labeled parts are <div><ol><li><b>Outside large jaws<\/b>: used to measure external diameter or width of an object<\/li><li><b>Inside small jaws<\/b>: used to measure internal diameter of an object<\/li><li><b>Depth probe\/rod<\/b>: used to measure depths of an object or a hole<\/li><li><b>Main scale (Metric)<\/b>: scale marked every mm<\/li><li><b>Main scale (Imperial)<\/b>: scale marked in inches and fractions<\/li><li><b>Vernier scale (Metric)<\/b> gives interpolated measurements to 0.1 mm or better<\/li><li><b>Vernier scale (Imperial)<\/b> gives interpolated measurements in fractions of an inch<\/li><li><b>Retainer<\/b>: used to block movable part to allow the easy transferring of a measurement<\/li><\/ol><\/div> The calipers in the diagram show a primary reading on the metric scale of about 2.475 cm (2.4 cm read from the main scale plus about 0.075 cm from the Vernier scale). Calipers often have a \"zero point error\", which is when the calipers do not read 0.000 cm when the jaws are closed. The zero point error must always be subtracted from the primary reading. Let us assume these calipers have a zero point error of 0.013 cm. This would give us a length reading of 2.462 cm. For any measurement, reporting the error on the measurement is also important. Both the primary reading and the zero point reading are bounded by plus\/minus <i>half<\/i> the length corresponding to the width of the smallest interval on the Vernier scale (0.0025 cm). These are \"absolute\" errors and absolute errors add, so the length reading is then bounded by plus\/minus the length corresponding to the <i>full<\/i> width of the smallest interval on the Vernier scale (0.005 cm). Assuming no systematics affect the measurement (the instrument works perfectly), a complete measurement would then read 2.462 cm \u00b1 0.005 cm.<\/div><\/div><\/div>\n<p>The vernier, dial, and digital calipers give a direct reading of the distance measured with high <a href=\"https:\/\/en.wikipedia.org\/wiki\/Accuracy_and_precision\" title=\"Accuracy and precision\" rel=\"external_link\" target=\"_blank\">accuracy and precision<\/a>. They are functionally identical, with different ways of reading the result. These calipers comprise a calibrated scale with a fixed jaw, and another jaw, with a pointer, that slides along the scale. The distance between the jaws is then read in different ways for the three types.\n<\/p><p>The simplest method is to read the position of the pointer directly on the scale. When the pointer is between two markings, the user can mentally <a href=\"https:\/\/en.wikipedia.org\/wiki\/Interpolation\" title=\"Interpolation\" rel=\"external_link\" target=\"_blank\">interpolate<\/a> to improve the precision of the reading. This would be a simple calibrated caliper; but the addition of a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Vernier_scale\" title=\"Vernier scale\" rel=\"external_link\" target=\"_blank\">vernier scale<\/a> allows more accurate interpolation, and is the universal practice; this is the <b>vernier caliper<\/b>.\n<\/p><p>Vernier, dial, and digital calipers can measure internal dimensions (using the uppermost jaws in the picture at right), external dimensions using the pictured lower jaws, and in many cases depth by the use of a probe that is attached to the movable head and slides along the centre of the body. This probe is slender and can get into deep grooves that may prove difficult for other measuring tools.\n<\/p><p>The vernier scales may include <a href=\"https:\/\/en.wikipedia.org\/wiki\/Metric_system\" title=\"Metric system\" rel=\"external_link\" target=\"_blank\">metric<\/a> measurements on the lower part of the scale and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Inch\" title=\"Inch\" rel=\"external_link\" target=\"_blank\">inch<\/a> measurements on the upper, or vice versa, in countries that use inches. Vernier calipers commonly used in industry provide a precision to 0.01 mm (10 <a href=\"https:\/\/en.wikipedia.org\/wiki\/Micrometre\" title=\"Micrometre\" rel=\"external_link\" target=\"_blank\">micrometres<\/a>), or one thousandth of an inch. They are available in sizes that can measure up to 1,829 mm (72 in).<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<div style=\"clear:both;\"><\/div>\n<h3><span class=\"mw-headline\" id=\"Dial_caliper\">Dial caliper<\/span><\/h3>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dial_calipers.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/96\/Dial_calipers.jpg\/220px-Dial_calipers.jpg\" width=\"220\" height=\"78\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Dial_calipers.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Mitutoyo\" title=\"Mitutoyo\" rel=\"external_link\" target=\"_blank\">Mitutoyo<\/a> dial caliper<\/div><\/div><\/div>\n<p>Instead of using a vernier mechanism, which requires some practice to use, the <b>dial caliper<\/b> reads the final fraction of a millimeter or inch on a simple dial.\n<\/p><p>In this instrument, a small, precise <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rack_and_pinion\" title=\"Rack and pinion\" rel=\"external_link\" target=\"_blank\">rack and pinion<\/a> drives a pointer on a circular <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dial_(measurement)\" title=\"Dial (measurement)\" rel=\"external_link\" target=\"_blank\">dial<\/a>, allowing direct reading without the need to read a vernier scale. Typically, the pointer rotates once every inch, tenth of an inch, or 1 millimeter. This measurement must be added to the coarse whole inches or centimeters read from the slide. The dial is usually arranged to be rotatable beneath the pointer, allowing for \"differential\" measurements (the measuring of the difference in size between two objects, or the setting of the dial using a master object and subsequently being able to read directly the plus-or-minus variance in size of subsequent objects relative to the master object).\n<\/p><p>The slide of a dial caliper can usually be locked at a setting using a small <a href=\"https:\/\/en.wikipedia.org\/wiki\/Lever\" title=\"Lever\" rel=\"external_link\" target=\"_blank\">lever<\/a> or screw; this allows simple <a href=\"https:\/\/en.wikipedia.org\/wiki\/Go-NoGo_gauge\" class=\"mw-redirect\" title=\"Go-NoGo gauge\" rel=\"external_link\" target=\"_blank\">go\/no-go<\/a> checks of part sizes.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Digital_caliper\">Digital caliper<\/span><\/h3>\n<div class=\"thumb tleft\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:DigitalCaliperEuro.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f2\/DigitalCaliperEuro.jpg\/220px-DigitalCaliperEuro.jpg\" width=\"220\" height=\"165\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:DigitalCaliperEuro.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Digital caliper<\/div><\/div><\/div>\n<p>A popular refinement replaces the analog dial with an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Electronics\" title=\"Electronics\" rel=\"external_link\" target=\"_blank\">electronic<\/a> <a href=\"https:\/\/en.wikipedia.org\/wiki\/Display_device\" title=\"Display device\" rel=\"external_link\" target=\"_blank\">digital display<\/a> that displays the reading as a numeric value. Rather than a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Rack_and_pinion\" title=\"Rack and pinion\" rel=\"external_link\" target=\"_blank\">rack and pinion<\/a>, these calipers use a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Linear_encoder\" title=\"Linear encoder\" rel=\"external_link\" target=\"_blank\">linear encoder<\/a>. Some digital calipers can be switched between centimeters or millimeters, and inches. All provide for zeroing the display at any point along the slide, allowing the same sort of differential measurements as with the dial caliper. Digital calipers may contain a \"reading hold\" feature, allowing the reading of dimensions after use in awkward locations where the display cannot be seen.\nOrdinary 6-in\/150-mm digital calipers are made of stainless steel, have a rated accuracy of 0.001 in (0.02mm) and a resolution of 0.0005 in (0.01 mm).<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\nThe same technology is used to make longer 8-in and 12-in calipers; the accuracy for longer measurements declines to 0.001 in (0.03 mm) for 100\u2013200 mm and 0.0015 in (0.04 mm) for 200\u2013300 mm.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup>\n<\/p><p>Increasingly, digital calipers offer a serial data output to allow them to be interfaced with a dedicated recorder or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Personal_computer\" title=\"Personal computer\" rel=\"external_link\" target=\"_blank\">personal computer<\/a>. The digital interface significantly decreases the time to make and record a series of measurements, and it also improves the reliability of the records. A suitable device to convert the serial data output to common computer interfaces such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/RS-232\" title=\"RS-232\" rel=\"external_link\" target=\"_blank\">RS-232<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Universal_Serial_Bus\" class=\"mw-redirect\" title=\"Universal Serial Bus\" rel=\"external_link\" target=\"_blank\">Universal Serial Bus<\/a>, or wireless can be built or purchased. With such a converter, measurements can be directly entered into a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Spreadsheet\" title=\"Spreadsheet\" rel=\"external_link\" target=\"_blank\">spreadsheet<\/a>, a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Statistical_process_control\" title=\"Statistical process control\" rel=\"external_link\" target=\"_blank\">statistical process control<\/a> program, or similar software.\n<\/p><p>The serial digital output varies among manufacturers. Common options are\n<\/p>\n<ul><li>Mitutoyo's Digimatic interface. This is the dominant name brand interface. Format is 52 bits arranged as 13 nibbles.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup><\/li>\n<li>Sylvac interface. This is the common protocol for inexpensive, non-name brand, calipers. Format is 24 bit 90 kHz synchronous.<sup id=\"rdp-ebb-cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\" rel=\"external_link\">[14]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-yadro_15-0\" class=\"reference\"><a href=\"#cite_note-yadro-15\" rel=\"external_link\">[15]<\/a><\/sup><\/li>\n<li>Starrett<sup id=\"rdp-ebb-cite_ref-muse142_16-0\" class=\"reference\"><a href=\"#cite_note-muse142-16\" rel=\"external_link\">[16]<\/a><\/sup><\/li>\n<li>Brown & Sharpe<sup id=\"rdp-ebb-cite_ref-muse142_16-1\" class=\"reference\"><a href=\"#cite_note-muse142-16\" rel=\"external_link\">[16]<\/a><\/sup><\/li>\n<li>Federal<\/li>\n<li>Tesa<sup id=\"rdp-ebb-cite_ref-muse142_16-2\" class=\"reference\"><a href=\"#cite_note-muse142-16\" rel=\"external_link\">[16]<\/a><\/sup><\/li>\n<li>Aldi. Format is 7 BCD digits.<sup id=\"rdp-ebb-cite_ref-yadro_15-1\" class=\"reference\"><a href=\"#cite_note-yadro-15\" rel=\"external_link\">[15]<\/a><\/sup><\/li>\n<li>Mahr (Digimatic, RS232C, Wireless FM Radio, Infrared and USB)<sup id=\"rdp-ebb-cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\" rel=\"external_link\">[17]<\/a><\/sup><\/li><\/ul>\n<p>Like dial calipers, the slide of a digital caliper can usually be locked using a lever or thumb-screw.\n<\/p><p>Some digital calipers contain a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Linear_encoder#Capacitive\" title=\"Linear encoder\" rel=\"external_link\" target=\"_blank\">capacitive linear encoder<\/a>. A pattern of bars is etched directly on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Printed_circuit_board\" title=\"Printed circuit board\" rel=\"external_link\" target=\"_blank\">printed circuit board<\/a> in the slider. Under the scale of the caliper another printed circuit board also contains an etched pattern of lines. The combination of these printed circuit boards forms two variable <a href=\"https:\/\/en.wikipedia.org\/wiki\/Capacitor\" title=\"Capacitor\" rel=\"external_link\" target=\"_blank\">capacitors<\/a>. The two capacitances are out of phase. As the slider moves the capacitance changes in a linear fashion and in a repeating pattern. The circuitry built into the slider counts the bars as the slider moves and does a linear interpolation based on the magnitudes of the capacitors to find the precise position of the slider. Other digital calipers contain an inductive linear encoder, which allows robust performance in the presence of contamination such as coolants.<sup id=\"rdp-ebb-cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\" rel=\"external_link\">[18]<\/a><\/sup> Magnetic linear encoders are used in yet other digital calipers.\n<\/p>\n<div style=\"clear:both;\"><\/div>\n<h3><span class=\"mw-headline\" id=\"Micrometer_caliper\">Micrometer caliper<\/span><\/h3>\n<div role=\"note\" class=\"hatnote navigation-not-searchable\">Main article: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Micrometer\" title=\"Micrometer\" rel=\"external_link\" target=\"_blank\">Micrometer<\/a><\/div>\n<p>A caliper using a calibrated <a href=\"https:\/\/en.wikipedia.org\/wiki\/Screw\" title=\"Screw\" rel=\"external_link\" target=\"_blank\">screw<\/a> for measurement, rather than a slide, is called an <i>external micrometer caliper gauge<\/i>, a <i>micrometer caliper<\/i> or, more often, simply a <i>micrometer<\/i>. (Sometimes the term <i>caliper<\/i>, referring to any other type in this article, is held in contradistinction to <i>micrometer<\/i>.)\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Comparison\">Comparison<\/span><\/h2>\n<p>Each of the above types of calipers has its relative merits and faults.\n<\/p><p>Vernier calipers are rugged and have long lasting accuracy, are coolant proof, are not affected by magnetic fields, and are largely shock proof. They may have both centimeter and inch scales. However, vernier calipers require good eyesight or a <a href=\"https:\/\/en.wikipedia.org\/wiki\/Magnifying_glass\" title=\"Magnifying glass\" rel=\"external_link\" target=\"_blank\">magnifying glass<\/a> to read and can be difficult to read from a distance or from awkward angles. It is relatively easy to misread the last digit. In production environments, reading vernier calipers all day long is error-prone and is annoying to the workers.\n<\/p><p>Dial calipers are comparatively easy to read, especially when seeking exact center by rocking and observing the needle movement. They can be set to 0 at any point for comparisons. They are usually fairly susceptible to shock damage. They are also very prone to getting dirt in the gears, which can cause accuracy problems.\n<\/p><p>Digital calipers switch easily between centimeter and inch systems.They can be set to 0 easily at any point with full count in either direction, and can take measurements even if the display is completely hidden, either by using a \"hold\" key, or by zeroing the display and closing the jaws, showing the correct measurement, but negative. They can be mechanically and electronically fragile. Most also require batteries, and do not resist coolant well. They are also only moderately shockproof, and can be vulnerable to dirt.\n<\/p><p>Calipers may read to a resolution of 0.01 mm or 0.0005 in, but accuracy may not be better than about \u00b10.02 mm or 0.001 in for 150 mm (6 in) calipers, and worse for longer ones.<sup id=\"rdp-ebb-cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\" rel=\"external_link\">[19]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Use\">Use<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:402px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Using_the_caliper_new_en.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c2\/Using_the_caliper_new_en.gif\/400px-Using_the_caliper_new_en.gif\" class=\"thumbimage\" style=\"width: 100%;max-width: 400px;height: auto;\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Using_the_caliper_new_en.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Using the vernier caliper<\/div><\/div><\/div>\n<p>A caliper must be properly applied against the part in order to take the desired measurement. For example, when measuring the thickness of a plate a vernier caliper must be held at right angles to the piece. Some practice may be needed to measure round or irregular objects correctly.\n<\/p><p>Accuracy of measurement when using a caliper is highly dependent on the skill of the operator. Regardless of type, a caliper's jaws must be forced into contact with the part being measured. As both part and caliper are always to some extent <a href=\"https:\/\/en.wikipedia.org\/wiki\/Elasticity_(physics)\" title=\"Elasticity (physics)\" rel=\"external_link\" target=\"_blank\">elastic<\/a>, the amount of force used affects the indication. A consistent, firm touch is correct. Too much force results in an underindication as part and tool distort; too little force gives insufficient contact and an overindication. This is a greater problem with a caliper incorporating a wheel, which lends <a href=\"https:\/\/en.wikipedia.org\/wiki\/Mechanical_advantage\" title=\"Mechanical advantage\" rel=\"external_link\" target=\"_blank\">mechanical advantage<\/a>. This is especially the case with digital calipers, calipers out of adjustment, or calipers with a poor quality beam.\n<\/p><p>Simple calipers are uncalibrated; the measurement taken must be compared against a scale. Whether the scale is part of the caliper or not, all analog calipers\u2014verniers and dials\u2014require good eyesight in order to achieve the highest precision. Digital calipers have the advantage in this area.\n<\/p><p>Calibrated calipers may be mishandled, leading to loss of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Calibration\" title=\"Calibration\" rel=\"external_link\" target=\"_blank\">zero<\/a>. When a calipers' jaws are fully closed, it should, of course, indicate zero. If it does not, it must be recalibrated or repaired. A vernier caliper does not easily lose its calibration but a sharp impact or accidental damage to the measuring surface in the caliper jaw can be significant enough to displace zero.<sup id=\"rdp-ebb-cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\" rel=\"external_link\">[20]<\/a><\/sup> Digital calipers have zero set buttons, for quick recalibration.\n<\/p><p>Vernier, dial and digital calipers can be used with accessories that extend their usefulness. Examples are a base that extends their usefulness as a depth gauge and a jaw attachment that allows measuring the center distance between holes. Since the 1970s a clever modification of the moveable jaw on the back side of any caliper allows for step or depth measurements in addition to external caliper measurements, in similar fashion to a universal micrometer (e.g., Starrett Mul-T-Anvil or Mitutoyo Uni-Mike).\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Zero_error\">Zero error<\/span><\/h2>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vernier_scale_zero_error_%2B0.10.gif\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/21\/Vernier_scale_zero_error_%2B0.10.gif\/220px-Vernier_scale_zero_error_%2B0.10.gif\" width=\"220\" height=\"109\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Vernier_scale_zero_error_%2B0.10.gif\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>When the jaws are closed and if the reading is 0.10 mm, the zero error is referred to as +0.10 mm. The method to use a vernier scale or caliper with zero error is to use the formula \"(actual reading) = (main scale) + (vernier scale) \u2212 (zero error)\", thus the actual reading is 19.00 + 0.54 \u2212 (0.10) = 19.44 mm. The resolution of the measurement, based on the width of the smallest sub-interval, is \u00b10.02 mm.<\/div><\/div><\/div>\n<p>The method to use a vernier scale or caliper with zero error is to use the formula \"actual reading = main scale + vernier scale \u2212 (zero error)\". Zero error may arise due to knocks that affect the calibration at 0.00 mm when the jaws are perfectly closed or just touching each other. Positive zero error refers to the fact that when the jaws of the vernier caliper are just closed, the reading is a positive reading away from the actual reading of 0.00 mm. If the reading is 0.10 mm, the zero error is referred to as +0.10 mm. Negative zero error refers to the fact that when the jaws of the vernier caliper are just closed, the reading is a negative reading away from the actual reading of 0.00 mm. If the reading is \u22120.08 mm, the zero error is referred to as \u22120.08 mm.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Dial_indicator\" class=\"mw-redirect\" title=\"Dial indicator\" rel=\"external_link\" target=\"_blank\">Dial indicator<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Cruising_rod\" title=\"Cruising rod\" rel=\"external_link\" target=\"_blank\">Cruising rod<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Lens_clock\" title=\"Lens clock\" rel=\"external_link\" target=\"_blank\">Lens clock<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist columns references-column-width\" style=\"-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-1\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Mensun Bound: <i>The Giglio wreck: a wreck of the Archaic period (c. 600 BC) off the Tuscany island of Giglio<\/i>, Hellenic Institute of Marine Archaeology, Athens 1991, pp. 27 and 31 (Fig. 65)<\/span>\n<\/li>\n<li id=\"cite_note-Roger_B._Ulrich-2\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-Roger_B._Ulrich_2-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-Roger_B._Ulrich_2-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\">Roger B. Ulrich: <i>Roman woodworking<\/i>, Yale University Press, New Haven, Conn., 2007, <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 0-300-10341-7, p.52f.<\/span>\n<\/li>\n<li id=\"cite_note-3\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-3\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">\"hand tool.\" Encyclop\u00e6dia Britannica from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Encyclop%C3%A6dia_Britannica_2006_Ultimate_Reference_Suite_DVD\" class=\"mw-redirect\" title=\"Encyclop\u00e6dia Britannica 2006 Ultimate Reference Suite DVD\" rel=\"external_link\" target=\"_blank\">Encyclop\u00e6dia Britannica 2006 Ultimate Reference Suite DVD<\/a>. [Accessed July 29, 2008]<\/span>\n<\/li>\n<li id=\"cite_note-Ronan-4\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-Ronan_4-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Colin A. Ronan; Joseph Needham (24 June 1994). <a rel=\"external_link\" class=\"external text\" href=\"#v=onepage&q&f=false\"><i>The Shorter Science and Civilisation in China: 4<\/i><\/a>. Cambridge University Press. p. 36. <a href=\"https:\/\/en.wikipedia.org\/wiki\/International_Standard_Book_Number\" title=\"International Standard Book Number\" rel=\"external_link\" target=\"_blank\">ISBN<\/a> 978-0-521-32995-8. <q>adjustable outside caliper gauge... self-dated at AD 9<\/q><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Shorter+Science+and+Civilisation+in+China%3A+4&rft.pages=36&rft.pub=Cambridge+University+Press&rft.date=1994-06-24&rft.isbn=978-0-521-32995-8&rft.au=Colin+A.+Ronan&rft.au=Joseph+Needham&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DPehoSnJfstUC%26pg%3DPA36%23v%3Donepage%26q%26f%3Dfalse&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/>. An abridged version.<\/span>\n<\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-5\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20140831052938\/http:\/\/history.cultural-china.com\/en\/56H2758H7991.html\" target=\"_blank\">\"Archived copy\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/history.cultural-china.com\/en\/56H2758H7991.html\" target=\"_blank\">the original<\/a> on 2014-08-31<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2013-11-26<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=http%3A%2F%2Fhistory.cultural-china.com%2Fen%2F56H2758H7991.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Archived copy as title (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Archived_copy_as_title\" title=\"Category:CS1 maint: Archived copy as title\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-6\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-6\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Joseph_Wickham_Roe\" title=\"Joseph Wickham Roe\" rel=\"external_link\" target=\"_blank\">Joseph Wickham Roe<\/a>, <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.org\/stream\/englishamericant00roej\/englishamericant00roej_djvu.txt\" target=\"_blank\"><i>English and American tool builders<\/i> (1916) p. 203<\/a><\/span>\n<\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-7\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external free\" href=\"http:\/\/www.mackinmfg.com\/\" target=\"_blank\">http:\/\/www.mackinmfg.com\/<\/a> shows a picture of the calipers but does not support the RAM claim.<\/span>\n<\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-8\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20100525030431\/http:\/\/www.starrett.com\/download\/246_p108_114.pdf\" target=\"_blank\">\"Archived copy\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.starrett.com\/download\/246_p108_114.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2010-05-25<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2010-06-25<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=http%3A%2F%2Fwww.starrett.com%2Fdownload%2F246_p108_114.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Archived copy as title (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Archived_copy_as_title\" title=\"Category:CS1 maint: Archived copy as title\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-9\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.harborfreight.com\/cpi\/ctaf\/displayitem.taf?Itemnumber=47257\" target=\"_blank\">\"Harbor Freight Tools \u2013 Quality Tools at Discount Prices Since 1977\"<\/a>. <i>www.harborfreight.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.harborfreight.com&rft.atitle=Harbor+Freight+Tools+%E2%80%93+Quality+Tools+at+Discount+Prices+Since+1977&rft_id=http%3A%2F%2Fwww.harborfreight.com%2Fcpi%2Fctaf%2Fdisplayitem.taf%3FItemnumber%3D47257&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-10\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20070726053453\/http:\/\/www.msi-viking.com\/digital_caliper\/\" target=\"_blank\">\"Archived copy\"<\/a>. Archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.msi-viking.com\/digital_caliper\/\" target=\"_blank\">the original<\/a> on 2007-07-26<span class=\"reference-accessdate\">. Retrieved <span class=\"nowrap\">2009-06-12<\/span><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Archived+copy&rft_id=http%3A%2F%2Fwww.msi-viking.com%2Fdigital_caliper%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><span class=\"citation-comment\" style=\"display:none; color:#33aa33; margin-left:0.3em\">CS1 maint: Archived copy as title (<a href=\"https:\/\/en.wikipedia.org\/wiki\/Category:CS1_maint:_Archived_copy_as_title\" title=\"Category:CS1 maint: Archived copy as title\" rel=\"external_link\" target=\"_blank\">link<\/a>) <\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131103082232\/http:\/\/www.mitutoyo.com\/pdf\/1715.pdf\" target=\"_blank\"><i>DRO System: Linear Scales & Counters<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>, Mitutoyo, n.d., p. 22, Bulletin No. 1715, archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mitutoyo.com\/pdf\/1715.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2013-11-03<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=DRO+System%3A+Linear+Scales+%26amp%3B+Counters&rft.pages=22&rft.pub=Mitutoyo&rft_id=http%3A%2F%2Fwww.mitutoyo.com%2Fpdf%2F1715.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-12\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-12\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131103082151\/http:\/\/www.mitutoyo.com\/pdf\/E4174-542.pdf\" target=\"_blank\"><i>Linear Gage<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>, Mitutoyo, n.d., p. 33, Catalog No. E4174-542\/572\/575, archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mitutoyo.com\/pdf\/E4174-542.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2013-11-03<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Linear+Gage&rft.pages=33&rft.pub=Mitutoyo&rft_id=http%3A%2F%2Fwww.mitutoyo.com%2Fpdf%2FE4174-542.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-13\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFLancaster2000\" class=\"citation\">Lancaster, Don (February 2000), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tinaja.com\/glib\/muse145.pdf\" target=\"_blank\">\"Tech Musings\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>, <i>Tech Musings<\/i>, <b>145<\/b><\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Tech+Musings&rft.atitle=Tech+Musings&rft.volume=145&rft.date=2000-02&rft.aulast=Lancaster&rft.aufirst=Don&rft_id=http%3A%2F%2Fwww.tinaja.com%2Fglib%2Fmuse145.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-14\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-14\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.shumatech.com\/support\/chinese_scales.htm\" target=\"_blank\">\"Chinese Scales\"<\/a>. <i>www.shumatech.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.shumatech.com&rft.atitle=Chinese+Scales&rft_id=http%3A%2F%2Fwww.shumatech.com%2Fsupport%2Fchinese_scales.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-yadro-15\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-yadro_15-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-yadro_15-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.yadro.de\/digital-scale\/protocol.html\" target=\"_blank\">Yadro<\/a> archive-date=2013-12-09 archive-url=<a rel=\"external_link\" class=\"external free\" href=\"https:\/\/web.archive.org\/web\/20131209053512\/http:\/\/yadro.de\/digital-scale\/protocol.html\" target=\"_blank\">https:\/\/web.archive.org\/web\/20131209053512\/http:\/\/yadro.de\/digital-scale\/protocol.html<\/a><\/span>\n<\/li>\n<li id=\"cite_note-muse142-16\"><span class=\"mw-cite-backlink\">^ <a href=\"#cite_ref-muse142_16-0\" rel=\"external_link\"><sup><i><b>a<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-muse142_16-1\" rel=\"external_link\"><sup><i><b>b<\/b><\/i><\/sup><\/a> <a href=\"#cite_ref-muse142_16-2\" rel=\"external_link\"><sup><i><b>c<\/b><\/i><\/sup><\/a><\/span> <span class=\"reference-text\"><cite id=\"rdp-ebb-CITEREFLancaster1999\" class=\"citation\">Lancaster, Don (November 1999), <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tinaja.com\/glib\/muse142.pdf\" target=\"_blank\">\"Tech Musings\"<\/a> <span class=\"cs1-format\">(PDF)<\/span>, <i>Tech Musings<\/i>, <b>142<\/b>: 142.3<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Tech+Musings&rft.atitle=Tech+Musings&rft.volume=142&rft.pages=142.3&rft.date=1999-11&rft.aulast=Lancaster&rft.aufirst=Don&rft_id=http%3A%2F%2Fwww.tinaja.com%2Fglib%2Fmuse142.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-17\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-17\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.cutwel.co.uk\/new-mahr-2015-catalogue\" target=\"_blank\">\"New Mahr 2015 Catalogue\"<\/a>. <i>www.Cutwel.co.uk<\/i>. Cutwel.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.Cutwel.co.uk&rft.atitle=New+Mahr+2015+Catalogue&rft_id=http%3A%2F%2Fwww.cutwel.co.uk%2Fnew-mahr-2015-catalogue&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-18\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/web.archive.org\/web\/20131103082314\/http:\/\/www.mitutoyo.com\/pdf\/ABS1813-293.pdf\" target=\"_blank\"><i>ABS Coolant Proof Caliper; Coolant Proof Micrometer<\/i><\/a> <span class=\"cs1-format\">(PDF)<\/span>, Mitutoyo, January 2005, Bulletin No. 1813-293\/500, archived from <a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.mitutoyo.com\/pdf\/ABS1813-293.pdf\" target=\"_blank\">the original<\/a> <span class=\"cs1-format\">(PDF)<\/span> on 2013-11-03<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=ABS+Coolant+Proof+Caliper%3B+Coolant+Proof+Micrometer&rft.pub=Mitutoyo&rft.date=2005-01&rft_id=http%3A%2F%2Fwww.mitutoyo.com%2Fpdf%2FABS1813-293.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-19\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation web\"><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.tresnainstrument.com\/accuracy_of_calipers.html\" target=\"_blank\">\"Accuracy of Calipers\"<\/a>. <i>www.tresnainstrument.com<\/i>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.tresnainstrument.com&rft.atitle=Accuracy+of+Calipers&rft_id=http%3A%2F%2Fwww.tresnainstrument.com%2Faccuracy_of_calipers.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-20\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation book\">Mitutoyo. <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/archive.org\/details\/E12024CheckPointsForMeasuringInstruments\" target=\"_blank\"><i>E 12024 Check Points For Measuring Instruments<\/i><\/a>. pp. 2, 3.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=E+12024+Check+Points+For+Measuring+Instruments&rft.pages=2%2C+3&rft.au=Mitutoyo&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2FE12024CheckPointsForMeasuringInstruments&rfr_id=info%3Asid%2Fen.wikipedia.org%3ACalipers\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<\/ol><\/div>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/www.compendiumarcana.com\/caliper\/\" target=\"_blank\">RS-232 Interface Design Details For Digital Caliper<\/a><\/li><\/ul>\n\n\n\n\n<p><!-- \nNewPP limit report\nParsed by mw1273\nCached time: 20181217065651\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.504 seconds\nReal time usage: 0.673 seconds\nPreprocessor visited node count: 1553\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 97340\/2097152 bytes\nTemplate argument size: 473\/2097152 bytes\nHighest expansion depth: 13\/40\nExpensive parser function count: 1\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 40796\/5000000 bytes\nNumber of Wikibase entities loaded: 1\/400\nLua time usage: 0.164\/10.000 seconds\nLua memory usage: 6.47 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 452.055 1 -total\n<\/p>\n<pre>47.31% 213.849 1 Template:Reflist\n15.07% 68.107 1 Template:ISBN\n12.37% 55.934 2 Template:Cite_book\n10.53% 47.583 1 Template:Convert\n 8.83% 39.922 1 Template:Catalog_lookup_link\n 8.29% 37.475 1 Template:Authority_control\n 7.80% 35.281 3 Template:Navbox\n 7.77% 35.115 1 Template:Other_uses\n 6.49% 29.318 7 Template:Cite_web\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:1635762-1!canonical and timestamp 20181217065650 and revision id 871937291\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Calipers\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214653\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.033 seconds\nReal time usage: 0.177 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 167.777 1 - wikipedia:Calipers\n100.00% 167.777 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8552-0!*!*!*!*!*!* and timestamp 20181217214653 and revision id 24980\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Calipers\">https:\/\/www.limswiki.org\/index.php\/Calipers<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","5bd64ab04b9fb048ddfb3cd4ff215fac_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/1\/18\/Caliper_detail_view.jpeg\/440px-Caliper_detail_view.jpe","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/73\/Calibro_archetto_graduato.JPG\/440px-Calibro_archetto_graduato.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/c3\/InsideCalipers.jpg\/440px-InsideCalipers.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/71\/OutsideCalipers.jpg\/440px-OutsideCalipers.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/c\/cd\/DividerCalipers.jpg\/440px-DividerCalipers.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/8\/83\/OddlegCalipers.jpg\/440px-OddlegCalipers.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f6\/Vernier_caliper.svg\/1200px-Vernier_caliper.svg.png","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/9\/96\/Dial_calipers.jpg\/440px-Dial_calipers.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/f\/f2\/DigitalCaliperEuro.jpg\/440px-DigitalCaliperEuro.jpg","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/c\/c2\/Using_the_caliper_new_en.gif","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/2\/21\/Vernier_scale_zero_error_%2B0.10.gif\/440px-Vernier_scale_zero_error_%2B0.10.gif","https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/a\/ae\/Using_a_DTApe.JPG\/140px-Using_a_DTApe.JPG","https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/4\/42\/Pine_forest_in_Sweden.jpg\/31px-Pine_forest_in_Sweden.jpg"],"5bd64ab04b9fb048ddfb3cd4ff215fac_timestamp":1545083213,"5ff57cc066e5fb627487105a67a6f125_type":"article","5ff57cc066e5fb627487105a67a6f125_title":"Surgical segment navigator","5ff57cc066e5fb627487105a67a6f125_url":"https:\/\/www.limswiki.org\/index.php\/Surgical_segment_navigator","5ff57cc066e5fb627487105a67a6f125_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tSurgical segment navigator\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t Surgical navigation for the orbit and zygoma on the SSN system (Color coding for the preoperative, predicted and goal position of the fragments, respectively)\nThe surgical segment navigator (SSN) is a computer-based system for use in surgical navigation. It is integrated into a common platform, together with the surgical tool navigator (STN), the surgical microscope navigator (SMN) and the 6DOF manipulator (MKM), developed by Carl Zeiss.\n\nContents \n\n1 SSN \n2 SSN++ \n3 References \n4 External links \n\n\nSSN \nThe SSN has been developed as a computer system for bone segment navigation in oral and maxillofacial surgery. It allows a very precise repositioning of bone fragments, with the advent of preoperative simulation and surgical planning.The system has been developed since 1997 at the University of Regensburg, Germany, with the support of the Carl Zeiss Company. Its principle is based on an infrared localisation system, composed of an infrared camera and at least three infrared transmitters attached to each bony fragment. The SSN is mainly used in orthognatic surgery (surgical correction of dysgnathia), but also for the surgical reconstruction of the orbit, or other surgical interventions to the midface.\n\n SSN++ \nSince 2001, at the University of Heidelberg, Germany, the SSN++ has been developed, a markerless-registration navigation system, based on a native (=markerless) CT or MRI. In this case, the patient registration is obtained on the operating table, using a surface scanner. The SSN++ correlates the surface scan data (gathered on the operating table) with the skin surface reconstruction from the dataset obtained preoperatively by CT or MRI. This principle complies with the terrain contour matching principle described for flying objects. The advantage of the new method is that the registration of the patient's position becomes a simple automated procedure; on the other hand, the radiation load for the patient is reduced, compared to the method using markers.\n\nReferences \nMarmulla R, Niederdellmann H: Computer-assisted Bone Segment Navigation, J Craniomaxillofac Surg 26: 347\u2013359, 1998\nMarmulla R, Niederdellmann H: Surgical Planning of Computer Assisted Repositioning Osteotomies, Plast Reconstr Surg 104 (4): 938\u2013944, 1999\nMarmulla R, M\u00fchling J, L\u00fcth T, Eggers G, Hassfeld S: Advanced surface-recording techniques for computer-assisted oral and maxillofacial surgery, Br J Oral Maxillofac Surg, 42: 511\u2013519, 2004\nExternal links \nSSN Homepage\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of the Wikipedia article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_segment_navigator\">https:\/\/www.limswiki.org\/index.php\/Surgical_segment_navigator<\/a>\n\t\t\t\t\tCategory: Medical softwareHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom 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id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Surgical segment navigator<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:SSNNavigation.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/7\/78\/SSNNavigation.jpg\/220px-SSNNavigation.jpg\" width=\"220\" height=\"141\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:SSNNavigation.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div><a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_segment_navigation\" title=\"Bone segment navigation\" rel=\"external_link\" target=\"_blank\">Surgical navigation<\/a> for the orbit and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Zygomatic_bone\" title=\"Zygomatic bone\" rel=\"external_link\" target=\"_blank\">zygoma<\/a> on the SSN system (Color coding for the preoperative, predicted and goal position of the fragments, respectively)<\/div><\/div><\/div>\n<p>The <b>surgical segment navigator (SSN)<\/b> is a computer-based system for use in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_navigation\" class=\"mw-redirect\" title=\"Surgical navigation\" rel=\"external_link\" target=\"_blank\">surgical navigation<\/a>. It is integrated into a common <a href=\"https:\/\/en.wikipedia.org\/wiki\/Platform_(computing)\" class=\"mw-redirect\" title=\"Platform (computing)\" rel=\"external_link\" target=\"_blank\">platform<\/a>, together with the surgical tool navigator (STN), the surgical microscope navigator (SMN) and the 6<a href=\"https:\/\/en.wikipedia.org\/wiki\/Degrees_of_freedom_(engineering)\" class=\"mw-redirect\" title=\"Degrees of freedom (engineering)\" rel=\"external_link\" target=\"_blank\">DOF<\/a> manipulator (MKM), developed by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carl_Zeiss_AG\" title=\"Carl Zeiss AG\" rel=\"external_link\" target=\"_blank\">Carl Zeiss<\/a>.\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"SSN\">SSN<\/span><\/h2>\n<p>The <b>SSN<\/b> has been developed as a computer system for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Bone_segment_navigation\" title=\"Bone segment navigation\" rel=\"external_link\" target=\"_blank\">bone segment navigation<\/a> in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Oral_and_maxillofacial_surgery\" title=\"Oral and maxillofacial surgery\" rel=\"external_link\" target=\"_blank\">oral and maxillofacial surgery<\/a>. It allows a very precise repositioning of bone fragments, with the advent of preoperative simulation and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_planning\" title=\"Surgical planning\" rel=\"external_link\" target=\"_blank\">surgical planning<\/a>.The system has been developed since 1997 at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Regensburg\" title=\"University of Regensburg\" rel=\"external_link\" target=\"_blank\">University of Regensburg, Germany<\/a>, with the support of the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Carl_Zeiss_AG\" title=\"Carl Zeiss AG\" rel=\"external_link\" target=\"_blank\">Carl Zeiss Company<\/a>. Its principle is based on an infrared localisation system, composed of an <a href=\"https:\/\/en.wikipedia.org\/wiki\/Infrared\" title=\"Infrared\" rel=\"external_link\" target=\"_blank\">infrared<\/a> camera and at least three infrared <a href=\"https:\/\/en.wikipedia.org\/wiki\/Transmitters\" class=\"mw-redirect\" title=\"Transmitters\" rel=\"external_link\" target=\"_blank\">transmitters<\/a> attached to each bony fragment. The SSN is mainly used in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Orthognatic_surgery\" class=\"mw-redirect\" title=\"Orthognatic surgery\" rel=\"external_link\" target=\"_blank\">orthognatic surgery<\/a> (surgical correction of dysgnathia), but also for the surgical reconstruction of the orbit, or other surgical interventions to the midface.\n<\/p>\n<h2><span id=\"rdp-ebb-SSN.2B.2B\"><\/span><span class=\"mw-headline\" id=\"SSN++\">SSN++<\/span><\/h2>\n<p>Since 2001, at the <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Heidelberg\" class=\"mw-redirect\" title=\"University of Heidelberg\" rel=\"external_link\" target=\"_blank\">University of Heidelberg, Germany<\/a>, the <b>SSN++<\/b> has been developed, a markerless-<a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_registration\" title=\"Patient registration\" rel=\"external_link\" target=\"_blank\">registration<\/a> navigation system, based on a native (=markerless) <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography\" class=\"mw-redirect\" title=\"Computed tomography\" rel=\"external_link\" target=\"_blank\">CT<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a>. In this case, the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_registration\" title=\"Patient registration\" rel=\"external_link\" target=\"_blank\">patient registration<\/a> is obtained on the operating table, using a surface scanner. The SSN++ correlates the surface scan data (gathered on the operating table) with the skin surface reconstruction from the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dataset\" class=\"mw-redirect\" title=\"Dataset\" rel=\"external_link\" target=\"_blank\">dataset<\/a> obtained preoperatively by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Computed_tomography\" class=\"mw-redirect\" title=\"Computed tomography\" rel=\"external_link\" target=\"_blank\">CT<\/a> or <a href=\"https:\/\/en.wikipedia.org\/wiki\/MRI\" class=\"mw-redirect\" title=\"MRI\" rel=\"external_link\" target=\"_blank\">MRI<\/a>. This principle complies with the <a href=\"https:\/\/en.wikipedia.org\/wiki\/TERCOM\" title=\"TERCOM\" rel=\"external_link\" target=\"_blank\">terrain contour matching<\/a> principle described for flying objects. The advantage of the new method is that the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Patient_registration\" title=\"Patient registration\" rel=\"external_link\" target=\"_blank\">registration of the patient's position<\/a> becomes a simple automated procedure; on the other hand, the radiation load for the patient is reduced, compared to the method using markers.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<ul><li>Marmulla R, Niederdellmann H: <i>Computer-assisted Bone Segment Navigation<\/i>, J Craniomaxillofac Surg 26: 347\u2013359, 1998<\/li>\n<li>Marmulla R, Niederdellmann H: <i>Surgical Planning of Computer Assisted Repositioning Osteotomies<\/i>, Plast Reconstr Surg 104 (4): 938\u2013944, 1999<\/li>\n<li>Marmulla R, M\u00fchling J, L\u00fcth T, Eggers G, Hassfeld S: <i>Advanced surface-recording techniques for computer-assisted oral and maxillofacial surgery<\/i>, Br J Oral Maxillofac Surg, 42: 511\u2013519, 2004<\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"External_links\">External links<\/span><\/h2>\n<ul><li><a rel=\"external_link\" class=\"external text\" href=\"http:\/\/marmulla.com\/compengl.htm\" target=\"_blank\">SSN Homepage<\/a><\/li><\/ul>\n<p><!-- \nNewPP limit report\nParsed by mw1275\nCached time: 20181126150205\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.012 seconds\nReal time usage: 0.018 seconds\nPreprocessor visited node count: 34\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 0\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/500\nUnstrip recursion depth: 0\/20\nUnstrip post\u2010expand size: 0\/5000000 bytes\nNumber of Wikibase entities loaded: 0\/400\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 0.000 1 -total\n-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:15753093-1!canonical and timestamp 20181126150205 and revision id 862034115\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Surgical_segment_navigator\" target=\"_blank\">the Wikipedia article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214652\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.014 seconds\nReal time usage: 0.100 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 95.123 1 - wikipedia:Surgical_segment_navigator\n100.00% 95.123 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8080-0!*!*!*!*!*!* and timestamp 20181217214652 and revision id 24198\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Surgical_segment_navigator\">https:\/\/www.limswiki.org\/index.php\/Surgical_segment_navigator<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","5ff57cc066e5fb627487105a67a6f125_images":["https:\/\/upload.wikimedia.org\/wikipedia\/commons\/7\/78\/SSNNavigation.jpg"],"5ff57cc066e5fb627487105a67a6f125_timestamp":1545083212,"459438aa577ac442814a6c6946908980_type":"article","459438aa577ac442814a6c6946908980_title":"Remote patient monitoring","459438aa577ac442814a6c6946908980_url":"https:\/\/www.limswiki.org\/index.php\/Remote_patient_monitoring","459438aa577ac442814a6c6946908980_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tRemote patient monitoring\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\tRemote patient monitoring (RPM) is a technology to enable monitoring of patients outside of conventional clinical settings (e.g. in the home), which may increase access to care and decrease healthcare delivery costs.\nIncorporating RPM in chronic disease management can significantly improve an individual's quality of life. It allows patients to maintain independence, prevent complications, and minimize personal costs.[1] RPM facilitates these goals by delivering care right to the home. In addition, patients and their family members feel comfort knowing that they are being monitored and will be supported if a problem arises. This is particularly important when patients are managing complex self-care processes such as home hemodialysis.[2]\nKey features of RPM, like remote monitoring and trend analysis of physiological parameters, enable early detection of deterioration; thereby, reducing number of emergency department visits, hospitalizations, and duration of hospital stays.[3]\nThe need for wireless mobility in healthcare facilitates the adoption of RPM both in community and institutional settings. The time saved as a result of RPM implementation increases efficiency, and allows healthcare providers to allocate more time to remotely educate and communicate with patients.[4][5][6]\n\n<\/p>\nContents \n\n1 Technological components \n2 Applications \n\n2.1 Dementia and falls \n2.2 Diabetes \n2.3 Congestive heart failure \n2.4 Infertility \n2.5 Early adopter: Veterans Health Administration \n2.6 Whole System Demonstrator Trial in UK \n\n\n3 Limitations \n4 Controversy \n5 See also \n6 References \n\n\nTechnological components \nThe diverse applications of RPM lead to numerous variations of RPM technology architecture. However, most RPM technologies follow a general architecture that consists of four components.:[7]\n\nSensors on a device that is enabled by wireless communications to measure physiological parameters.\nLocal data storage at patients\u2019 site that interfaces between sensors and other centralized data repository and\/or healthcare providers.\nCentralized repository to store data sent from sensors, local data storage, diagnostic applications, and\/or healthcare providers.\nDiagnostic application software that develops treatment recommendations and intervention alerts based on the analysis of collected data.\nDepending on the disease and the parameters that are monitored, different combinations of sensors, storage, and applications may be deployed.[4][7]\n\nApplications \nPhysiological data such as blood pressure and subjective patient data are collected by sensors on peripheral devices. Examples of peripheral devices are: blood pressure cuff, pulse oximeter, and glucometer. The data are transmitted to healthcare providers or third parties via wireless telecommunication devices. The data are evaluated for potential problems by a healthcare professional or via a clinical decision support algorithm, and patient, caregivers, and health providers are immediately alerted if a problem is detected.[3] As a result, timely intervention ensures positive patient outcomes. The newer applications also provide education, test and medication reminder alerts, and a means of communication between the patient and the provider.[3] The following section illustrates examples of RPM applications, but RPM is not limited to those disease states.\n\nDementia and falls \n Telehealth Response Watch\nFor patients with dementia that are at risk for falls, RPM technology promotes safety and prevents harm through continuous surveillance.[3] RPM sensors can be affixed to the individual or their assistive mobility devices such as canes and walkers.[3] The sensors monitor an individual\u2019s location, gait, linear acceleration and angular velocity, and utilize a mathematical algorithm to predict the likelihood for falls, detect movement changes, and alert caregivers if the individual has fallen.[3] Furthermore, tracking capabilities via Wi-Fi, global positioning system (GPS) or radio frequency enables caregivers to locate wandering elders.[3]\n\nDiabetes \nDiabetes management requires control of multiple parameters: blood pressure, weight, and blood glucose. The real-time delivery of blood glucose and blood pressure readings enables immediate alerts for patient and healthcare providers to intervene when needed. There is evidence to show that daily diabetes management involving RPM is just as effective as usual clinic visit every 3 months.[8]\n\nCongestive heart failure \nA systematic review of the literature on home monitoring for heart failure patients indicates that RPM improves quality of life, improves patient-provider relationships, shortens duration of stay in hospitals, decreases mortality rate, and reduces costs to the healthcare system.[9]\n\nInfertility \nA recent study of a remote patient monitoring solution for infertility demonstrated that for appropriately screened patients who had been seeking In-Vitro Fertilization (IVF) treatment, a six-month remote monitoring program had the same pregnancy rate as a cycle of IVF.[10] The remote patient monitoring product and service used had a cost-per-patient of $800, compared to the average cost of a cycle of IVF of $15,000, suggesting a 95% reduction in the cost of care for the same outcome.\n\nEarly adopter: Veterans Health Administration \nThe Veterans Health Administration (VHA), United States\u2019 largest integrated healthcare system, is highly involved in the implementation and evaluation of RPM technologies. It has expanded use of RPM beyond common chronic disease applications, to post-traumatic stress disorder, cancer and palliative care.[5] VHA\u2019s findings indicate improvements in a wide range of metrics, including decrease in emergency department visits, hospitalizations, and nursing home admissions.[5] Findings from the VHA Care Coordination\/Home Telehealth program show that RPM deployment resulted in significant savings to the organization.[11]\n\nWhole System Demonstrator Trial in UK \nThe UK\u2019s Department of Health\u2019s Whole System Demonstrator (WSD)[12] launched in May 2008. It is the largest randomised control trial of telehealth and telecare in the world, involving 6191 patients and 238 GP practices across three sites, Newham, Kent and Cornwall. The trials were evaluated by: City University London, University of Oxford, University of Manchester, Nuffield Trust, Imperial College London and London School of Economics.\n\n45% reduction in mortality rates\n20% reduction in emergency admissions\n15% reduction in A&E visits\n14% reduction in elective admissions\n14% reduction in bed days\n8% reduction in tariff costs\nIn the UK, the Government's Care Services minister, Paul Burstow, has stated that telehealth and telecare would be extended over the next five years (2012-2017) to reach three million people.[13]\n\nLimitations \nRPM is highly dependent on the individual\u2019s motivation to manage their health. Without the patient\u2019s willingness to be an active participant in their care, RPM implementation will likely fail. Cost is also a barrier to its widespread use. \nThere is a lack of reimbursement guidelines for RPM services, which may deter its incorporation into clinical practice.[7]\nThe shift of accountability associated with RPM brings up liability issues.[7] There are no clear guidelines in respect to whether clinicians have to intervene every time they receive an alert regardless of the urgency.\nThe continuous flow of patient data requires a dedicated team of health care providers to handle the information, which may, in fact, increase the workload. Although technology is introduced with the intent to increase efficiency, it can become a barrier to some healthcare providers that are not technological.\nThere are common obstacles that health informatics technologies encounter that applies to RPM. Depending on the comorbidities monitored, RPM involves a diverse selection of devices in its implementation. Standardization is required for data exchange and interoperability among multiple components. Furthermore, RPM deployment is highly dependent on an extensive wireless telecommunications infrastructure, which may not be available or feasible in rural areas. Since RPM involves transmission of sensitive patient data across telecommunication networks, information security is a concern.[7]\n\nControversy \nPublished by the New England Journal of Medicine, a randomized controlled trial involving congestive heart failure patients concluded that the use of telemonitoring failed to provide a benefit over usual care.[14] The telemonitoring patient group was instructed to call a designated number daily, and answer a series of questions about their symptoms using a keypad.[14] Clearly, the process described by Chaudhry et al. (2010) differs from the RPM methodology illustrated in the overview, which involves actual collection and transmission of physiological data through point-of-care devices. With articles[15][16] from Forbes associating RPM with the negative findings by Chaudhry et al. (2010), it may be difficult to clear the misconception that telemonitoring is synonymous with remote patient monitoring. The lack of standardization of RPM nomenclature and definition makes it difficult to differentiate between different forms of patient monitoring involving technology.\n\nSee also \nBiotelemetry\nTelehealth\neHealth\nmHealth\nReferences \n\n\n^ Bayliss, E.; Steiner, J.F.; Fernald, D.H.; Crane, L.A.; Main, D.S. (2003). \"Descriptions of barriers to self-care by persons with comorbid chronic diseases\". Ann Fam Med. 1 (1): 15\u201321. doi:10.1370\/afm.4. PMC 1466563 . \n\n^ Cafazzo, J.A., Leonard, K., Easty, A.C., Rossos, P.G., & Chan, C.T. (2009). Bridging the self-care deficit gap: remote patient monitoring and hospital at home. In Electronic Healthcare First International Conference, eHealth 2008. doi:10.1007\/978-3-642-00413-1_8 \n\n^ a b c d e f g Center for Technology and Aging. (2009, December). Technologies for remote patient monitoring in older adults discussion paper. Retrieved from http:\/\/www.techandaging.org\/RPMpositionpaperDraft.pdf \n\n^ a b O'Donoghue, John; Herbert, John (2012). \"Data Management within mHealth Environments: Patient Sensors, Mobile Devices, and Databases\". J. Data and Information Quality. 4: 1\u201320. doi:10.1145\/2378016.2378021. \n\n^ a b c Coye, M.; Haskelkorn, A.; Demello, S. (2009). \"Remote patient management: technology-enabled innovation and evolving business models for chronic disease care\". Health Affairs. 28 (1): 126\u2013135. doi:10.1377\/hlthaff.28.1.126. \n\n^ Vavilis, S., Petkovi\u0107, M., & Zannone, N. (2012). Impact of ICT on home healthcare . In ICT Critical Infrastructures and Society (pp. 111-122). Springer Berlin Heidelberg. \n\n^ a b c d e Smith, T. & Sweeney, R. (2010, September). Fusion trends and opportunities. Medical devices and communications. Retrieved from http:\/\/www.nerac.com\/nerac_insights.php?category=reports&id=279 \n\n^ Chase, H.P.; Pearson, J.A.; Wightman, C.; Roberts, M.D.; Oderberg, A.D.; Garg, S.K. \"Modem transmission of glucose values reduces the costs and need for clinic visits\". Diabetes Care. 26 (5): 1475\u20131479. doi:10.2337\/diacare.26.5.1475. \n\n^ Mart\u00ednez, A.; Everss, E.; Rojo-Alvarez, J.L.; Figal, D.P.; Garc\u00eda-Alberola, A. (2006). \"A systematic review of the literature on home monitoring for patients with heart failure\". J Telemed Telecare. 12 (5): 234\u201341. doi:10.1258\/135763306777889109. \n\n^ Chausiaux, O.; Hayes, J.; Long, C.; Morris, S.; Williams, G.; Husheer, S. (2011). \"Pregnancy Prognosis in Infertile Couples on the DuoFertility Programme Compared with In Vitro Fertilisation\/Intracytoplasmic Sperm Injection\". European Obstetrics & Gynaecology. 6 (2): 92\u20134. \n\n^ Darkins, A.; Ryan, P.; Kobb, R.; Foster, L; Edmonson, E.; Wakefield, B.; Lancaster, A.E. (2008). \"Care coordination\/home Telehealth: the systematic implementation of health informatics, home Telehealth, and disease management to support the care of Veteran patients with chronic conditions\". Telemed J E-Health. 14 (10): 1118\u20131126. doi:10.1089\/tmj.2008.0021. \n\n^ Whole Systems Demonstrators: An Overview of Telecare and Telehealth \n\n^ 3 Million Lives Announcement \n\n^ a b Chaudhry, S.I.; Mattera, J.A.; Curtis, J.P.; Spertus, J.A.; Herrin, J.; Lin, Z.; Phillips, C.O.; Hodshon, B.V.; Coopers, L.S.; Krumholz, H.M. (2010). \"Telemonitoring in patients with heart failure\". N Engl J Med. 363: 2301\u20132309. doi:10.1056\/nejmoa1010029. PMC 3237394 . \n\n^ Langreth, R. (2010, November 18). \"Why remote patient monitoring is overhyped\". Forbes. Retrieved from https:\/\/www.forbes.com\/sites\/robertlangreth\/2010\/11\/18\/why-telemedicine-is-overhyped\/2\/ \n\n^ Krumholz, H. (2010, November 19). \"A double whammy for remote patient monitoring\". Forbes. Retrieved from https:\/\/www.forbes.com\/sites\/sciencebiz\/2010\/11\/19\/a-double-whammy-for-remote-patient-monitoring\/ \n\n\n\n\n\n<\/pre>\n\nNotes \nThis article is a direct transclusion of article and therefore may not meet the same editing standards as LIMSwiki.\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Remote_patient_monitoring\">https:\/\/www.limswiki.org\/index.php\/Remote_patient_monitoring<\/a>\n\t\t\t\t\tCategories: Healthcare termsMedical devicesMedical monitoring and signal processingMedical softwareHidden category: Articles transcluded from other wikis\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable version\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\n\t\tSponsors\n\t\t\n\t\t\t \r\n\n\t\r\n\n\t\r\n\n\t\r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n \r\n\n\t\n\t\r\n\n\t\n\t\r\n\n\t\r\n\n\t\r\n\n\t\r\n\t\t\n\t\t\n\t\t\t\n\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t This page was last modified on 16 August 2016, at 17:19.\n\t\t\t\t\t\t\t\t\tThis page has been accessed 938 times.\n\t\t\t\t\t\t\t\t\tContent is available under a Creative Commons Attribution-ShareAlike 4.0 International License unless otherwise noted.\n\t\t\t\t\t\t\t\t\tPrivacy policy\n\t\t\t\t\t\t\t\t\tAbout LIMSWiki\n\t\t\t\t\t\t\t\t\tDisclaimers\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\t\n\n","459438aa577ac442814a6c6946908980_html":"<body class=\"mediawiki ltr sitedir-ltr ns-0 ns-subject page-Remote_patient_monitoring skin-monobook action-view\">\n<div id=\"rdp-ebb-globalWrapper\">\n\t\t<div id=\"rdp-ebb-column-content\">\n\t\t\t<div id=\"rdp-ebb-content\" class=\"mw-body\" role=\"main\">\n\t\t\t\t<a id=\"rdp-ebb-top\"><\/a>\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<h1 id=\"rdp-ebb-firstHeading\" class=\"firstHeading\" lang=\"en\">Remote patient monitoring<\/h1>\n\t\t\t\t\n\t\t\t\t<div id=\"rdp-ebb-bodyContent\" class=\"mw-body-content\">\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\n\t\t\t\t\t<!-- start content -->\n\t\t\t\t\t<div id=\"rdp-ebb-mw-content-text\" lang=\"en\" dir=\"ltr\" class=\"mw-content-ltr\"><div class=\"mw-parser-output\"><p><b>Remote patient monitoring<\/b> (<b>RPM<\/b>) is a technology to enable monitoring of patients outside of conventional clinical settings (e.g. in the home), which may increase access to care and decrease healthcare delivery costs.\n<\/p><p>Incorporating RPM in <a href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_disease\" class=\"mw-redirect\" title=\"Chronic disease\" rel=\"external_link\" target=\"_blank\">chronic disease<\/a> management can significantly improve an individual's <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quality_of_life\" title=\"Quality of life\" rel=\"external_link\" target=\"_blank\">quality of life<\/a>. It allows patients to maintain independence, prevent complications, and minimize personal costs.<sup id=\"rdp-ebb-cite_ref-bayliss_1-0\" class=\"reference\"><a href=\"#cite_note-bayliss-1\" rel=\"external_link\">[1]<\/a><\/sup> RPM facilitates these goals by delivering care right to the home. In addition, patients and their family members feel comfort knowing that they are being monitored and will be supported if a problem arises. This is particularly important when patients are managing complex <a href=\"https:\/\/en.wikipedia.org\/wiki\/Self-care\" title=\"Self-care\" rel=\"external_link\" target=\"_blank\">self-care<\/a> processes such as home <a href=\"https:\/\/en.wikipedia.org\/wiki\/Hemodialysis\" title=\"Hemodialysis\" rel=\"external_link\" target=\"_blank\">hemodialysis<\/a>.<sup id=\"rdp-ebb-cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\" rel=\"external_link\">[2]<\/a><\/sup>\n<p>Key features of RPM, like remote monitoring and trend analysis of physiological parameters, enable early detection of deterioration; thereby, reducing number of emergency department visits, hospitalizations, and duration of hospital stays.<sup id=\"rdp-ebb-cite_ref-center_3-0\" class=\"reference\"><a href=\"#cite_note-center-3\" rel=\"external_link\">[3]<\/a><\/sup>\nThe need for wireless mobility in healthcare facilitates the adoption of RPM both in community and institutional settings. The time saved as a result of RPM implementation increases efficiency, and allows healthcare providers to allocate more time to remotely educate and communicate with patients.<sup id=\"rdp-ebb-cite_ref-dx.doi.org_4-0\" class=\"reference\"><a href=\"#cite_note-dx.doi.org-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-coye_5-0\" class=\"reference\"><a href=\"#cite_note-coye-5\" rel=\"external_link\">[5]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-ict_6-0\" class=\"reference\"><a href=\"#cite_note-ict-6\" rel=\"external_link\">[6]<\/a><\/sup>\n<\/p>\n<\/p>\n\n<h2><span class=\"mw-headline\" id=\"Technological_components\">Technological components<\/span><\/h2>\n<p>The diverse applications of RPM lead to numerous variations of RPM technology architecture. However, most RPM technologies follow a general architecture that consists of four components.:<sup id=\"rdp-ebb-cite_ref-smith_7-0\" class=\"reference\"><a href=\"#cite_note-smith-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<ul><li>Sensors on a device that is enabled by wireless communications to measure physiological parameters.<\/li>\n<li>Local data storage at patients\u2019 site that interfaces between sensors and other centralized data repository and\/or healthcare providers.<\/li>\n<li>Centralized repository to store data sent from sensors, local data storage, diagnostic applications, and\/or healthcare providers.<\/li>\n<li>Diagnostic application software that develops treatment recommendations and intervention alerts based on the analysis of collected data.<\/li><\/ul>\n<p>Depending on the disease and the parameters that are monitored, different combinations of sensors, storage, and applications may be deployed.<sup id=\"rdp-ebb-cite_ref-dx.doi.org_4-1\" class=\"reference\"><a href=\"#cite_note-dx.doi.org-4\" rel=\"external_link\">[4]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-smith_7-1\" class=\"reference\"><a href=\"#cite_note-smith-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Applications\">Applications<\/span><\/h2>\n<p>Physiological data such as <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure\" title=\"Blood pressure\" rel=\"external_link\" target=\"_blank\">blood pressure<\/a> and subjective patient data are collected by sensors on peripheral devices. Examples of peripheral devices are: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure_cuff\" class=\"mw-redirect\" title=\"Blood pressure cuff\" rel=\"external_link\" target=\"_blank\">blood pressure cuff<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Pulse_oximeter\" class=\"mw-redirect\" title=\"Pulse oximeter\" rel=\"external_link\" target=\"_blank\">pulse oximeter<\/a>, and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Glucometer\" class=\"mw-redirect\" title=\"Glucometer\" rel=\"external_link\" target=\"_blank\">glucometer<\/a>. The data are transmitted to healthcare providers or third parties via wireless telecommunication devices. The data are evaluated for potential problems by a healthcare professional or via a clinical decision support algorithm, and patient, caregivers, and health providers are immediately alerted if a problem is detected.<sup id=\"rdp-ebb-cite_ref-center_3-1\" class=\"reference\"><a href=\"#cite_note-center-3\" rel=\"external_link\">[3]<\/a><\/sup> As a result, timely intervention ensures positive patient outcomes. The newer applications also provide education, test and medication reminder alerts, and a means of communication between the patient and the provider.<sup id=\"rdp-ebb-cite_ref-center_3-2\" class=\"reference\"><a href=\"#cite_note-center-3\" rel=\"external_link\">[3]<\/a><\/sup> The following section illustrates examples of RPM applications, but RPM is not limited to those disease states.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Dementia_and_falls\">Dementia and falls<\/span><\/h3>\n<div class=\"thumb tright\"><div class=\"thumbinner\" style=\"width:222px;\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Telehealth_-_Response_Watch.jpg\" class=\"image\" rel=\"external_link\" target=\"_blank\"><img alt=\"\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/b\/b5\/Telehealth_-_Response_Watch.jpg\/220px-Telehealth_-_Response_Watch.jpg\" width=\"220\" height=\"361\" class=\"thumbimage\" \/><\/a> <div class=\"thumbcaption\"><div class=\"magnify\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/File:Telehealth_-_Response_Watch.jpg\" class=\"internal\" title=\"Enlarge\" rel=\"external_link\" target=\"_blank\"><\/a><\/div>Telehealth Response Watch<\/div><\/div><\/div>\n<p>For patients with <a href=\"https:\/\/en.wikipedia.org\/wiki\/Dementia\" title=\"Dementia\" rel=\"external_link\" target=\"_blank\">dementia<\/a> that are at risk for falls, RPM technology promotes safety and prevents harm through continuous surveillance.<sup id=\"rdp-ebb-cite_ref-center_3-3\" class=\"reference\"><a href=\"#cite_note-center-3\" rel=\"external_link\">[3]<\/a><\/sup> RPM sensors can be affixed to the individual or their assistive mobility devices such as canes and walkers.<sup id=\"rdp-ebb-cite_ref-center_3-4\" class=\"reference\"><a href=\"#cite_note-center-3\" rel=\"external_link\">[3]<\/a><\/sup> The sensors monitor an individual\u2019s location, gait, linear acceleration and angular velocity, and utilize a mathematical algorithm to predict the likelihood for falls, detect movement changes, and alert caregivers if the individual has fallen.<sup id=\"rdp-ebb-cite_ref-center_3-5\" class=\"reference\"><a href=\"#cite_note-center-3\" rel=\"external_link\">[3]<\/a><\/sup> Furthermore, tracking capabilities via <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wi-Fi\" title=\"Wi-Fi\" rel=\"external_link\" target=\"_blank\">Wi-Fi<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Global_positioning_system\" class=\"mw-redirect\" title=\"Global positioning system\" rel=\"external_link\" target=\"_blank\">global positioning system<\/a> (GPS) or radio frequency enables caregivers to locate wandering elders.<sup id=\"rdp-ebb-cite_ref-center_3-6\" class=\"reference\"><a href=\"#cite_note-center-3\" rel=\"external_link\">[3]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Diabetes\">Diabetes<\/span><\/h3>\n<p><a href=\"https:\/\/en.wikipedia.org\/wiki\/Diabetes\" class=\"mw-redirect\" title=\"Diabetes\" rel=\"external_link\" target=\"_blank\">Diabetes<\/a> management requires control of multiple parameters: <a href=\"https:\/\/en.wikipedia.org\/wiki\/Blood_pressure\" title=\"Blood pressure\" rel=\"external_link\" target=\"_blank\">blood pressure<\/a>, weight, and blood glucose. The real-time delivery of blood glucose and blood pressure readings enables immediate alerts for patient and healthcare providers to intervene when needed. There is evidence to show that daily diabetes management involving RPM is just as effective as usual clinic visit every 3 months.<sup id=\"rdp-ebb-cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\" rel=\"external_link\">[8]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Congestive_heart_failure\">Congestive heart failure<\/span><\/h3>\n<p>A systematic review of the literature on home monitoring for <a href=\"https:\/\/en.wikipedia.org\/wiki\/Heart_failure\" title=\"Heart failure\" rel=\"external_link\" target=\"_blank\">heart failure<\/a> patients indicates that RPM improves <a href=\"https:\/\/en.wikipedia.org\/wiki\/Quality_of_life\" title=\"Quality of life\" rel=\"external_link\" target=\"_blank\">quality of life<\/a>, improves patient-provider relationships, shortens duration of stay in hospitals, decreases mortality rate, and reduces costs to the healthcare system.<sup id=\"rdp-ebb-cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\" rel=\"external_link\">[9]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Infertility\">Infertility<\/span><\/h3>\n<p>A recent study of a remote patient monitoring solution for infertility demonstrated that for appropriately screened patients who had been seeking In-Vitro Fertilization (IVF) treatment, a six-month remote monitoring program had the same pregnancy rate as a cycle of IVF.<sup id=\"rdp-ebb-cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\" rel=\"external_link\">[10]<\/a><\/sup> The remote patient monitoring product and service used had a cost-per-patient of $800, compared to the average cost of a cycle of IVF of $15,000, suggesting a 95% reduction in the cost of care for the same outcome.\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Early_adopter:_Veterans_Health_Administration\">Early adopter: Veterans Health Administration<\/span><\/h3>\n<p>The Veterans Health Administration (VHA), United States\u2019 largest integrated healthcare system, is highly involved in the implementation and evaluation of RPM technologies. It has expanded use of RPM beyond common chronic disease applications, to post-traumatic stress disorder, cancer and palliative care.<sup id=\"rdp-ebb-cite_ref-coye_5-1\" class=\"reference\"><a href=\"#cite_note-coye-5\" rel=\"external_link\">[5]<\/a><\/sup> VHA\u2019s findings indicate improvements in a wide range of metrics, including decrease in emergency department visits, hospitalizations, and nursing home admissions.<sup id=\"rdp-ebb-cite_ref-coye_5-2\" class=\"reference\"><a href=\"#cite_note-coye-5\" rel=\"external_link\">[5]<\/a><\/sup> Findings from the VHA Care Coordination\/Home Telehealth program show that RPM deployment resulted in significant savings to the organization.<sup id=\"rdp-ebb-cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\" rel=\"external_link\">[11]<\/a><\/sup>\n<\/p>\n<h3><span class=\"mw-headline\" id=\"Whole_System_Demonstrator_Trial_in_UK\">Whole System Demonstrator Trial in UK<\/span><\/h3>\n<p>The UK\u2019s Department of Health\u2019s Whole System Demonstrator (WSD)<sup id=\"rdp-ebb-cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\" rel=\"external_link\">[12]<\/a><\/sup> launched in May 2008. It is the largest randomised control trial of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telehealth\" title=\"Telehealth\" rel=\"external_link\" target=\"_blank\">telehealth<\/a> and telecare in the world, involving 6191 patients and 238 GP practices across three sites, <a href=\"https:\/\/en.wikipedia.org\/wiki\/London_Borough_of_Newham\" title=\"London Borough of Newham\" rel=\"external_link\" target=\"_blank\">Newham<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Kent\" title=\"Kent\" rel=\"external_link\" target=\"_blank\">Kent<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/Cornwall\" title=\"Cornwall\" rel=\"external_link\" target=\"_blank\">Cornwall<\/a>. The trials were evaluated by: <a href=\"https:\/\/en.wikipedia.org\/wiki\/City_University_London\" class=\"mw-redirect\" title=\"City University London\" rel=\"external_link\" target=\"_blank\">City University London<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Oxford\" title=\"University of Oxford\" rel=\"external_link\" target=\"_blank\">University of Oxford<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/University_of_Manchester\" title=\"University of Manchester\" rel=\"external_link\" target=\"_blank\">University of Manchester<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Nuffield_Trust\" title=\"Nuffield Trust\" rel=\"external_link\" target=\"_blank\">Nuffield Trust<\/a>, <a href=\"https:\/\/en.wikipedia.org\/wiki\/Imperial_College_London\" title=\"Imperial College London\" rel=\"external_link\" target=\"_blank\">Imperial College London<\/a> and <a href=\"https:\/\/en.wikipedia.org\/wiki\/London_School_of_Economics\" title=\"London School of Economics\" rel=\"external_link\" target=\"_blank\">London School of Economics<\/a>.\n<\/p>\n<ul><li>45% reduction in mortality rates<\/li>\n<li>20% reduction in emergency admissions<\/li>\n<li>15% reduction in A&E visits<\/li>\n<li>14% reduction in elective admissions<\/li>\n<li>14% reduction in bed days<\/li>\n<li>8% reduction in tariff costs<\/li><\/ul>\n<p>In the UK, the Government's Care Services minister, Paul Burstow, has stated that <a href=\"https:\/\/en.wikipedia.org\/wiki\/Telehealth\" title=\"Telehealth\" rel=\"external_link\" target=\"_blank\">telehealth<\/a> and telecare would be extended over the next five years (2012-2017) to reach three million people.<sup id=\"rdp-ebb-cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\" rel=\"external_link\">[13]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Limitations\">Limitations<\/span><\/h2>\n<p>RPM is highly dependent on the individual\u2019s motivation to manage their health. Without the patient\u2019s willingness to be an active participant in their care, RPM implementation will likely fail. Cost is also a barrier to its widespread use. \nThere is a lack of reimbursement guidelines for RPM services, which may deter its incorporation into clinical practice.<sup id=\"rdp-ebb-cite_ref-smith_7-2\" class=\"reference\"><a href=\"#cite_note-smith-7\" rel=\"external_link\">[7]<\/a><\/sup>\nThe shift of accountability associated with RPM brings up liability issues.<sup id=\"rdp-ebb-cite_ref-smith_7-3\" class=\"reference\"><a href=\"#cite_note-smith-7\" rel=\"external_link\">[7]<\/a><\/sup> There are no clear guidelines in respect to whether clinicians have to intervene every time they receive an alert regardless of the urgency.\nThe continuous flow of patient data requires a dedicated team of <a href=\"https:\/\/en.wikipedia.org\/wiki\/Health_care_providers\" class=\"mw-redirect\" title=\"Health care providers\" rel=\"external_link\" target=\"_blank\">health care providers<\/a> to handle the information, which may, in fact, increase the workload. Although technology is introduced with the intent to increase efficiency, it can become a barrier to some healthcare providers that are not technological.\nThere are common obstacles that health informatics technologies encounter that applies to RPM. Depending on the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Comorbidities\" class=\"mw-redirect\" title=\"Comorbidities\" rel=\"external_link\" target=\"_blank\">comorbidities<\/a> monitored, RPM involves a diverse selection of devices in its implementation. Standardization is required for data exchange and interoperability among multiple components. Furthermore, RPM deployment is highly dependent on an extensive <a href=\"https:\/\/en.wikipedia.org\/wiki\/Wireless_telecommunications\" class=\"mw-redirect\" title=\"Wireless telecommunications\" rel=\"external_link\" target=\"_blank\">wireless telecommunications<\/a> infrastructure, which may not be available or feasible in rural areas. Since RPM involves transmission of sensitive patient data across telecommunication networks, information security is a concern.<sup id=\"rdp-ebb-cite_ref-smith_7-4\" class=\"reference\"><a href=\"#cite_note-smith-7\" rel=\"external_link\">[7]<\/a><\/sup>\n<\/p>\n<h2><span class=\"mw-headline\" id=\"Controversy\">Controversy<\/span><\/h2>\n<p>Published by the <a href=\"https:\/\/en.wikipedia.org\/wiki\/New_England_Journal_of_Medicine\" class=\"mw-redirect\" title=\"New England Journal of Medicine\" rel=\"external_link\" target=\"_blank\">New England Journal of Medicine<\/a>, a randomized controlled trial involving congestive heart failure patients concluded that the use of telemonitoring failed to provide a benefit over usual care.<sup id=\"rdp-ebb-cite_ref-chan_14-0\" class=\"reference\"><a href=\"#cite_note-chan-14\" rel=\"external_link\">[14]<\/a><\/sup> The telemonitoring patient group was instructed to call a designated number daily, and answer a series of questions about their symptoms using a keypad.<sup id=\"rdp-ebb-cite_ref-chan_14-1\" class=\"reference\"><a href=\"#cite_note-chan-14\" rel=\"external_link\">[14]<\/a><\/sup> Clearly, the process described by Chaudhry et al. (2010) differs from the RPM methodology illustrated in the overview, which involves actual collection and transmission of physiological data through point-of-care devices. With articles<sup id=\"rdp-ebb-cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\" rel=\"external_link\">[15]<\/a><\/sup><sup id=\"rdp-ebb-cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\" rel=\"external_link\">[16]<\/a><\/sup> from <a href=\"https:\/\/en.wikipedia.org\/wiki\/Forbes\" title=\"Forbes\" rel=\"external_link\" target=\"_blank\">Forbes<\/a> associating RPM with the negative findings by Chaudhry et al. (2010), it may be difficult to clear the misconception that telemonitoring is synonymous with remote patient monitoring. The lack of standardization of RPM nomenclature and definition makes it difficult to differentiate between different forms of patient monitoring involving technology.\n<\/p>\n<h2><span class=\"mw-headline\" id=\"See_also\">See also<\/span><\/h2>\n<ul><li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Biotelemetry\" title=\"Biotelemetry\" rel=\"external_link\" target=\"_blank\">Biotelemetry<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Telehealth\" title=\"Telehealth\" rel=\"external_link\" target=\"_blank\">Telehealth<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/EHealth\" title=\"EHealth\" rel=\"external_link\" target=\"_blank\">eHealth<\/a><\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/MHealth\" title=\"MHealth\" rel=\"external_link\" target=\"_blank\">mHealth<\/a><\/li><\/ul>\n<h2><span class=\"mw-headline\" id=\"References\">References<\/span><\/h2>\n<div class=\"reflist\" style=\"list-style-type: decimal;\">\n<div class=\"mw-references-wrap mw-references-columns\"><ol class=\"references\">\n<li id=\"cite_note-bayliss-1\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-bayliss_1-0\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Bayliss, E.; Steiner, J.F.; Fernald, D.H.; Crane, L.A.; Main, D.S. (2003). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1466563\" target=\"_blank\">\"Descriptions of barriers to self-care by persons with comorbid chronic diseases\"<\/a>. <i>Ann Fam Med<\/i>. <b>1<\/b> (1): 15\u201321. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1370%2Fafm.4\" target=\"_blank\">10.1370\/afm.4<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1466563\" target=\"_blank\">1466563<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ann+Fam+Med&rft.atitle=Descriptions+of+barriers+to+self-care+by+persons+with+comorbid+chronic+diseases&rft.volume=1&rft.issue=1&rft.pages=15-21&rft.date=2003&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1466563&rft_id=info%3Adoi%2F10.1370%2Fafm.4&rft.aulast=Bayliss&rft.aufirst=E.&rft.au=Steiner%2C+J.F.&rft.au=Fernald%2C+D.H.&rft.au=Crane%2C+L.A.&rft.au=Main%2C+D.S.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1466563&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+patient+monitoring\" class=\"Z3988\"><\/span><\/span>\n<\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-2\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Cafazzo, J.A., Leonard, K., Easty, A.C., Rossos, P.G., & Chan, C.T. 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(2011). \"Pregnancy Prognosis in Infertile Couples on the DuoFertility Programme Compared with In Vitro Fertilisation\/Intracytoplasmic Sperm Injection\". <i>European Obstetrics & Gynaecology<\/i>. <b>6<\/b> (2): 92\u20134.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Obstetrics+%26+Gynaecology&rft.atitle=Pregnancy+Prognosis+in+Infertile+Couples+on+the+DuoFertility+Programme+Compared+with+In+Vitro+Fertilisation%2FIntracytoplasmic+Sperm+Injection&rft.volume=6&rft.issue=2&rft.pages=92-4&rft.date=2011&rft.aulast=Chausiaux&rft.aufirst=O.&rft.au=Hayes%2C+J.&rft.au=Long%2C+C.&rft.au=Morris%2C+S.&rft.au=Williams%2C+G.&rft.au=Husheer%2C+S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+patient+monitoring\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-11\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\"><cite class=\"citation journal\">Darkins, A.; Ryan, P.; Kobb, R.; Foster, L; Edmonson, E.; Wakefield, B.; Lancaster, A.E. 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(2010). <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3237394\" target=\"_blank\">\"Telemonitoring in patients with heart failure\"<\/a>. <i>N Engl J Med<\/i>. <b>363<\/b>: 2301\u20132309. <a href=\"https:\/\/en.wikipedia.org\/wiki\/Digital_object_identifier\" title=\"Digital object identifier\" rel=\"external_link\" target=\"_blank\">doi<\/a>:<a rel=\"external_link\" class=\"external text\" href=\"https:\/\/doi.org\/10.1056%2Fnejmoa1010029\" target=\"_blank\">10.1056\/nejmoa1010029<\/a>. <a href=\"https:\/\/en.wikipedia.org\/wiki\/PubMed_Central\" title=\"PubMed Central\" rel=\"external_link\" target=\"_blank\">PMC<\/a> <span class=\"cs1-lock-free\" title=\"Freely accessible\"><a rel=\"external_link\" class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3237394\" target=\"_blank\">3237394<\/a><\/span>.<\/cite><span title=\"ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=N+Engl+J+Med&rft.atitle=Telemonitoring+in+patients+with+heart+failure&rft.volume=363&rft.pages=2301-2309&rft.date=2010&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3237394&rft_id=info%3Adoi%2F10.1056%2Fnejmoa1010029&rft.aulast=Chaudhry&rft.aufirst=S.I.&rft.au=Mattera%2C+J.A.&rft.au=Curtis%2C+J.P.&rft.au=Spertus%2C+J.A.&rft.au=Herrin%2C+J.&rft.au=Lin%2C+Z.&rft.au=Phillips%2C+C.O.&rft.au=Hodshon%2C+B.V.&rft.au=Coopers%2C+L.S.&rft.au=Krumholz%2C+H.M.&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3237394&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARemote+patient+monitoring\" class=\"Z3988\"><\/span><link rel=\"mw-deduplicated-inline-style\" href=\"mw-data:TemplateStyles:r861714446\"\/><\/span>\n<\/li>\n<li id=\"cite_note-15\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-15\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Langreth, R. (2010, November 18). \"Why remote patient monitoring is overhyped\". Forbes. Retrieved from <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.forbes.com\/sites\/robertlangreth\/2010\/11\/18\/why-telemedicine-is-overhyped\/2\/\" target=\"_blank\">https:\/\/www.forbes.com\/sites\/robertlangreth\/2010\/11\/18\/why-telemedicine-is-overhyped\/2\/<\/a><\/span>\n<\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><b><a href=\"#cite_ref-16\" rel=\"external_link\">^<\/a><\/b><\/span> <span class=\"reference-text\">Krumholz, H. (2010, November 19). \"A double whammy for remote patient monitoring\". Forbes. Retrieved from <a rel=\"external_link\" class=\"external free\" href=\"https:\/\/www.forbes.com\/sites\/sciencebiz\/2010\/11\/19\/a-double-whammy-for-remote-patient-monitoring\/\" target=\"_blank\">https:\/\/www.forbes.com\/sites\/sciencebiz\/2010\/11\/19\/a-double-whammy-for-remote-patient-monitoring\/<\/a><\/span>\n<\/li>\n<\/ol><\/div><\/div>\n<p><!-- \nNewPP limit report\nParsed by mw1266\nCached time: 20181209114542\nCache expiry: 1900800\nDynamic content: false\nCPU time usage: 0.216 seconds\nReal time usage: 0.253 seconds\nPreprocessor visited node count: 805\/1000000\nPreprocessor generated node count: 0\/1500000\nPost\u2010expand include size: 17595\/2097152 bytes\nTemplate argument size: 315\/2097152 bytes\nHighest expansion depth: 9\/40\nExpensive parser function count: 2\/500\nUnstrip recursion depth: 1\/20\nUnstrip post\u2010expand size: 30359\/5000000 bytes\nNumber of Wikibase entities loaded: 2\/400\nLua time usage: 0.119\/10.000 seconds\nLua memory usage: 3.14 MB\/50 MB\n-->\n<!--\nTransclusion expansion time report (%,ms,calls,template)\n100.00% 197.322 1 Template:Reflist\n100.00% 197.322 1 -total\n<\/p>\n<pre>81.18% 160.187 8 Template:Cite_journal\n 5.31% 10.481 1 Template:Doi\n 2.80% 5.533 2 Template:Hide_in_print\n 1.37% 2.708 1 Template:Main_other\n 1.26% 2.480 1 Template:Only_in_print\n 1.25% 2.464 1 Template:Str_left\n<\/pre>\n<p>-->\n<\/p><p><!-- Saved in parser cache with key enwiki:pcache:idhash:33537087-1!canonical and timestamp 20181209114541 and revision id 845122510\n<\/p>\n<pre>-->\n<\/pre>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Notes\">Notes<\/span><\/h2>\n<p>This article is a direct transclusion of <a rel=\"external_link\" class=\"external text\" href=\"https:\/\/en.wikipedia.org\/wiki\/Remote_patient_monitoring\" target=\"_blank\">article<\/a> and therefore may not meet the same editing standards as LIMSwiki.\n<\/p>\n<!-- \nNewPP limit report\nCached time: 20181217214652\nCache expiry: 86400\nDynamic content: false\nCPU time usage: 0.027 seconds\nReal time usage: 0.168 seconds\nPreprocessor visited node count: 5\/1000000\nPreprocessor generated node count: 20\/1000000\nPost\u2010expand include size: 20\/2097152 bytes\nTemplate argument size: 0\/2097152 bytes\nHighest expansion depth: 2\/40\nExpensive parser function count: 0\/100\n-->\n\n<!-- \nTransclusion expansion time report (%,ms,calls,template)\n100.00% 161.217 1 - wikipedia:Remote_patient_monitoring\n100.00% 161.217 1 - -total\n-->\n\n<!-- Saved in parser cache with key limswiki:pcache:idhash:8551-0!*!*!*!*!*!* and timestamp 20181217214652 and revision id 27020\n -->\n<\/div><div class=\"printfooter\">Source: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Remote_patient_monitoring\">https:\/\/www.limswiki.org\/index.php\/Remote_patient_monitoring<\/a><\/div>\n\t\t\t\t\t\t\t\t\t\t<!-- end content -->\n\t\t\t\t\t\t\t\t\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<!-- end of the left (by default at least) column -->\n\t\t<div class=\"visualClear\"><\/div>\n\t\t\t\t\t\n\t\t<\/div>\n\t\t\n\n<\/body>","459438aa577ac442814a6c6946908980_images":["https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/b\/b5\/Telehealth_-_Response_Watch.jpg\/440px-Telehealth_-_Response_Watch.jpg"],"459438aa577ac442814a6c6946908980_timestamp":1545083212,"523b73ff51fa83663dc0b1d59e6d0f05_type":"article","523b73ff51fa83663dc0b1d59e6d0f05_title":"Picture archiving and communication system","523b73ff51fa83663dc0b1d59e6d0f05_url":"https:\/\/www.limswiki.org\/index.php\/Picture_archiving_and_communication_system","523b73ff51fa83663dc0b1d59e6d0f05_plaintext":"\n\n\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\n\t\t\t\tPicture archiving and communication system\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\tFrom LIMSWiki\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\tJump to: navigation, search\n\n\t\t\t\t\t\n\t\t\t\t\t This image demonstrates a basic set of interconnections among a PACS, a radiology information system (RIS), the imaging modalities, and other components of the PACS, standardized by DICOM.\nA picture archiving and communication system (PACS) is a digital imaging system composed of a set of components that allow for the digital acquisition, archiving, communication, retrieval, processing, distribution, and display of medical images.[1] The PACS may consist of only a few components or be sufficiently complex to handle a hospital or healthcare enterprise environment. Regardless, it must be durable enough for daily use in a clinical environment, integrate to and from several medical imaging modalities, and have sufficient workstations for technicians utilizing those modalities to perform their work inside and outside the radiology department.[1] PACS benefit healthcare providers by digitally managing medical images, eliminating the need to manually file, retrieve, or transport film jackets. This often saves processing time in both the diagnostics and reporting related to the imagery, especially when integrated with speech recognition technology.[2]\n\nContents\n\n1 History \n2 Technology \n3 See also \n4 References \n\n\n\nHistory \nWhile the theoretical concepts surrounding a digital image management system were around as early as the late 1970s, the idea didn't solidify until the January 1982 First International Conference and Workshop on Picture Archiving and Communications Systems in Newport Beach, California.[1] There researcher Carla Marceau defined the PACS as \"a digital system for acquiring, storing, moving and displaying picture or image information.\"[3] This was followed soon after (July 1982) by the The First International Symposium on PACS and PHD (Personal Health Data) in Japan and the EuroPACS annual conference in 1983. Another meeting dedicated to PACS occurred in Evian, France in October 1990, dubbed \"central to the formation of a critical PACS project: the Medical Diagnostic Imaging Support System.\"[1] By late 1997, the disparate PACS groups spread across the United States, Japan, and Europe began working together to form some truly international PACS implementations. This international effort was buoyed by the internationalization of the DICOM standard in 1993, globalization of imaging manufacturers, and sharing of PACS information and experiences among the groups.\n\nTechnology \nA quality PACS design depends on system connectivity and workflow efficiency. It features a standardized, open architecture and is expandable for future growth. Hardware includes imaging device interfaces, storage devices, communication networks, patient data servers, display tools, and imaging modalities \"integrated by a standardized, flexible software system for communication, database management, storage management, job scheduling, interprocessor communication, error handling, and network monitoring.\"[1] Other components that necessarily integrate to the PACS include a radiology information system (RIS) and a hospital information system (HIS), extending its effectiveness even further. All of these components \"talk\" to each other in no small part because of the DICOM (Digital Imaging and Communications in Medicine) standard which ensures a uniform handling, storing, printing, and transmitting of medical imaging data.[1][4] \nThis interfacing between multiple systems provides more consistent and reliable data by reducing the risk of entering incorrect patient information (through QA and error checking) and by strengthening merged datasets across multiple systems by using a unique, transferable ID like an NHS or Social Security number. Analysis and reporting also becomes more integrated and rapid across the entire provider-patient pipeline.[4]\n\nSee also \n Imaging informatics\n DICOM\n Radiology information system\n Medical imaging software (open source)\nReferences \n\n\u2191 1.0 1.1 1.2 1.3 1.4 1.5 Huang, H. K. (2010). \"Chapter 1: Introduction\". PACS and Imaging Informatics: Basic Principles and Applications. John Wiley & Sons. pp. 1\u201330. ISBN 9780470560518. http:\/\/books.google.com\/books?id=Pjjkyae_55oC&pg=PA1 . Retrieved 09 June 2014 .   \n\n\u2191 Fox, Matthew A.; Aschkenasi, Carl J.; Kalyanpur, Arjun (2013). \"Voice recognition is here comma like it or not period\". Indian Journal of Radiology and Imaging 23 (3): 191\u2013194. doi:10.4103\/0971-3026.120252. PMID 24347844. http:\/\/www.ijri.org\/article.asp?issn=0971-3026;year=2013;volume=23;issue=3;spage=191;epage=194;aulast=Fox . Retrieved 09 June 2014 .   \n\n\u2191 Marceau, Carla (14 January 1982). \"What Is A Picture Archiving And Communication System (PACS)?\". Proceedings of SPIE (1st Intl Conf and Workshop on Picture Archiving and Communication Systems) 0318: 24. doi:10.1117\/12.967618. http:\/\/spie.org\/Publications\/Proceedings\/Volume\/0318 . Retrieved 09 June 2014 .   \n\n\u2191 4.0 4.1 Ralston, Matthew D.; Coleman, Robert M. (2009). \"Chapter 3: Introduction to PACS\". Practical Imaging Informatics: Foundations and Applications for PACS Professionals. Springer. pp. 33\u201348. ISBN 9781441904850. http:\/\/books.google.com\/books?id=Q6Hc0oMyiYYC&pg=PA33 . Retrieved 09 June 2014 .   \n\n\n\n\n\n\n\n\nSource: <a rel=\"external_link\" class=\"external\" href=\"https:\/\/www.limswiki.org\/index.php\/Picture_archiving_and_communication_system\">https:\/\/www.limswiki.org\/index.php\/Picture_archiving_and_communication_system<\/a>\n\t\t\t\t\tCategories: Imaging informaticsMedical imagingSoftware systems\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\n\t\t\n\t\t\tNavigation menu\n\t\t\t\t\t\n\t\t\tViews\n\n\t\t\t\n\t\t\t\t\n\t\t\t\tPage\n\t\t\t\tDiscussion\n\t\t\t\tView source\n\t\t\t\tHistory\n\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\t\n\t\t\t\tPersonal tools\n\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\tLog in\n\t\t\t\t\t\t\t\t\t\t\t\t\tRequest account\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\t\n\t\t\t\n\t\t\t\t\n\t\tNavigation\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tMain page\n\t\t\t\t\t\t\t\t\t\t\tRecent changes\n\t\t\t\t\t\t\t\t\t\t\tRandom page\n\t\t\t\t\t\t\t\t\t\t\tHelp\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tSearch\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\t\n\t\t\t\t\n\n\t\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\tTools\n\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tWhat links here\n\t\t\t\t\t\t\t\t\t\t\tRelated changes\n\t\t\t\t\t\t\t\t\t\t\tSpecial pages\n\t\t\t\t\t\t\t\t\t\t\tPermanent link\n\t\t\t\t\t\t\t\t\t\t\tPage information\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\n\t\t\n\t\t\n\t\tPrint\/export\n\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\tCreate a book\n\t\t\t\t\t\t\t\t\t\t\tDownload as PDF\n\t\t\t\t\t\t\t\t\t\t\tDownload as Plain text\n\t\t\t\t\t\t\t\t\t\t\tPrintable
